Prognostic Factors and Clinical Prediction Score for Progressive Respiratory Failure in Severe COVID-19 Pneumonia Patients Treated with Tocilizumab: A Multicenter Study
Issued Date
2025-01-01
Resource Type
ISSN
11766336
eISSN
1178203X
Scopus ID
2-s2.0-105025402636
Journal Title
Therapeutics and Clinical Risk Management
Volume
21
Start Page
1783
End Page
1793
Rights Holder(s)
SCOPUS
Bibliographic Citation
Therapeutics and Clinical Risk Management Vol.21 (2025) , 1783-1793
Suggested Citation
Pongtarakulpanit N., Jayanama K., Phinyo P., Naothavorn W., Nuprom S., Pitidhammabhorn D., Ngammisri P., Ngamjanyaporn P., Suthichatchawan V., Wicharit L., Thammavaranucupt K. Prognostic Factors and Clinical Prediction Score for Progressive Respiratory Failure in Severe COVID-19 Pneumonia Patients Treated with Tocilizumab: A Multicenter Study. Therapeutics and Clinical Risk Management Vol.21 (2025) , 1783-1793. 1793. doi:10.2147/TCRM.S567679 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/113718
Title
Prognostic Factors and Clinical Prediction Score for Progressive Respiratory Failure in Severe COVID-19 Pneumonia Patients Treated with Tocilizumab: A Multicenter Study
Corresponding Author(s)
Other Contributor(s)
Abstract
Purpose: A proportion of COVID-19 pneumonia patients develop respiratory failure despite tocilizumab administration. This retrospective cohort study aimed to identify prognostic factors associated with progressive respiratory failure within 14 days among patients with severe COVID-19 pneumonia treated with Tocilizumab and to describe treatment outcomes. Patients and Methods: Patients with severe COVID-19 pneumonia were assessed, and their demographic, clinical, laboratory data, and prior treatment were collected on the day of tocilizumab administration. A multivariable Cox proportional hazard model was employed to identify prognostic factors. Results: Of the 109 patients, 32 (29.4%) progressed to respiratory failure. We identified the following independent prognostic factors for progressive respiratory failure: pulse oximetry saturation to fraction of inspired oxygen ratio (SpO<inf>2</inf>/FiO<inf>2</inf>) ≤ 160 (HR 2.97, 95% CI 1.41–6.23, P = 0.004), estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m<sup>2</sup> (HR 3.21, 95% CI 1.23–8.39, P = 0.017), and serum potassium ≤ 4 mmol/L (HR 2.82, 95% CI 1.38–5.80, P = 0.005). A predictive model based on these factors effectively stratified the risk of progressive respiratory failure (area under the curve = 0.72, 95% CI 0.63–0.80). Patients experiencing progressive respiratory failure had poor clinical outcomes, with a mortality rate of 62.5%, compared to 0.0% in the non-respiratory failure group (p < 0.001). Conclusion: In severe COVID-19 pneumonia patients treated with Tocilizumab, low SpO<inf>2</inf>/FiO<inf>2</inf> ratio, low eGFR, and relatively low serum potassium were independent predictors for progressive respiratory failure. This simple clinical score may help identify high-risk patients early, though external validation is required before routine implementation.