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dc.contributor.authorRodríguez-Baño, Jesús
dc.contributor.authorPachón, Jerónimo
dc.contributor.authorCarratalà, Jordi
dc.contributor.authorRyan, Pablo
dc.contributor.authorJarrin-Vera, Inmaculada 
dc.contributor.authorYllescas, María
dc.contributor.authorArribas, José Ramón
dc.contributor.authorBerenguer, Juan
dc.identifier.citationClin Microbiol Infect. 2021 Feb;27(2):244-252.es_ES
dc.description.abstractThe objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situation.es_ES
dc.description.sponsorshipSAM-COVID was funded by Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (COV20/01031) co-funded by European Union (ERDF/ESF, “Investing in your future”) and Fundación SEIMC/GeSIDA. In addition, Juan Berenguer, Jesús Rodríguez-Baño, Inmaculada Jarrín, Jordi Carratalá, Jerónimo Pachón, and José R Arribas received funding for research from Plan Nacional de I+D+i 2013-2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades – co- financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014–2020 through the networks: Spanish AIDS Research Network (RIS) [RD16/0025/0017 (JB), RD16/0025/0018 (JRA), RD16/0025/00XX (IJ)] and Spanish Network for Research in Infectious Diseases (REIPI)[RD16/0016/0001 (JRB), RD16/0016/0005 (JC), and RD16/0016/0009 (JP).es_ES
dc.publisherElsevier es_ES
dc.relation.isversionofPublisher's versiones_ES
dc.subject.meshCohort studyes_ES
dc.subject.meshHyperinflammatory statees_ES
dc.subject.meshMortality es_ES
dc.titleTreatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)es_ES
dc.rights.licenseAtribución-NoComercial-SinObraDerivada 4.0 Internacional*
dc.contributor.funderMinisterio de Ciencia e Innovación
dc.contributor.funderFundación SEIMC/GeSIDA
dc.contributor.funderInstituto de Salud Carlos III 
dc.contributor.funderEuropean Regional Development Fund (ERDF/FEDER)
dc.contributor.funderRed Española de Investigación en SIDA
dc.contributor.funderRed Española de Investigación en Patología Infecciosa
dc.identifier.journalClinical microbiology and infectiones_ES
dc.repisalud.centroISCIII::Centro Nacional de Epidemologíaes_ES

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Atribución-NoComercial-SinObraDerivada 4.0 Internacional
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