Little is known about the immuno-inflammatory response to Tocilizumab and its association with outcome in critically-ill SARS-CoV2 pneumonia. In this multicenter retrospective cohort of SARS-CoV-2 patients admitted to three intensive care units between March and April 2020, we matched on gender and SAPS II 21 Tocilizumab-treated patients to 42 non-treated patients. Need for mechanical ventilation was 76% versus 79%. IL-6, C-reactive protein, and fibrinogen had been collected within the first days of admission (T1), 3 d (T2) and 7 d (T3) later. Tocilizumab-treated patients had persistently higher IL-6 plasma levels and persistently lower C-Reactive protein and fibrinogen levels. Among Tocilizumab-treated patients, baseline levels of inflammatory biomarkers were not different according to outcome. Conversely, C-reactive protein and fibrinogen decrease was delayed in non-survivors. C-Reactive protein decreased at T1 in survivors (45 [30–98] vs 170 [69–204] mg/l, P < 0.001) but only at T2 in non-survivors (37 [13–74] vs 277 [235–288], P = 0.03). Fibrinogen decreased at T2 in survivors (4.11 [3.58–4.69] vs 614 [5.61–7.85] g/l, P = 0.005) but not in non-survivors (4.79 [4.12–7.58] vs 7.24 [6.22–9.24] g/l, P = 0.125). Tocilizumab treatment was thus associated with a persistent both increase in plasma IL-6, and decrease in C-reactive protein and fibrinogen. Among Tocilizumab-treated patients, the decrease in inflammatory biomarkers was delayed in non-survivors.

对托珠单抗的免疫炎症反应及其与重症 SARS-CoV2 肺炎结局的关系知之甚少。在这个 2020 年 3 月至 4 月间入住三个重症监护室的 SARS-CoV-2 患者的多中心回顾性队列中，我们将性别和 SAPS II 21 名接受托珠单抗治疗的患者与 42 名未接受治疗的患者进行了匹配。机械通气需求为 76% 和 79%。IL-6、C反应蛋白和纤维蛋白原在入院第一天（T1）、3天（T2）和7天（T3）后收集。接受托珠单抗治疗的患者血浆 IL-6 水平持续升高，C 反应蛋白和纤维蛋白原水平持续降低。在接受托珠单抗治疗的患者中，炎症生物标志物的基线水平没有因结果而异。反过来，非幸存者的 C 反应蛋白和纤维蛋白原减少延迟。幸存者在 T1 时 C 反应蛋白降低（45 [30–98] vs 170 [69–204] mg/l，P  < 0.001）但仅在非幸存者的 T2 时（37 [13-74] vs 277 [235-288]，P  = 0.03）。幸存者在 T2 时纤维蛋白原减少（4.11 [3.58–4.69] vs 614 [5.61–7.85] g/l，P  = 0.005），但在非幸存者中没有下降（4.79 [4.12–7.58] vs 7.24 [6.22–9.24] g/升，P  = 0.125）。因此，托珠单抗治疗与血浆 IL-6 的持续增加以及 C 反应蛋白和纤维蛋白原的减少有关。在接受托珠单抗治疗的患者中，炎症生物标志物的减少在非幸存者中有所延迟。