Comparison of interleukin-6 receptor antagonist and pulse steroid therapy in critically ill patients with COVID-19: retrospective analysis

Aims: Severe COVID-19 is characterized by acute respiratory distress syndrome accompanied by hypercytokinemia. In our study, we aimed to demonstrate the efficacy of the treatments such as interleukin-6 receptor antagonists and corticosteroids used in critically ill patients with COVID-19. Methods: COVID-patients with cytokine storm treated in the intensive care unit between March 2020 and July 2021 were included in the study. Patients with increased neutrophil/lymphocyte ratio, lactate dehydrogenase, C-reactive protein, and ferritin and patients with oxygen saturations of 90% or lower, lymphopenia and fever were also considered to be in cytokine storm. Patients were divided into three groups: Tocilizumab Group, Steroid Group, Standard treatment Group. Results: There was no statistically significant difference between the groups in terms of age and body mass index averages, gender ratios and concomitant diseases. The duration of stay in the intensive care unit and time on mechanical ventilation were found to be longer in the toculizimab group. There was no difference in mortality and the need for mechanical ventilation between the groups. On the other hand, ventilator-associated pneumonias were found to be higher in the pulse steroid group. Conclusion: The close follow-up of the patients and early diagnosis of hypercytokinemia increase the success of the treatment, and accelerate to discharge from intensive care units. We think that it is important to select appropriate patients and pulse steroid is more suitable for use in cytokine storm because it is cheaper and more accessible.