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Clinical Prediction Guide Mussini C, Cozzi-Lepri A, Menozzi M, et al. Development and validation of a prediction model for tocilizumab failure in hospitalized patients with SARS-CoV-2 infection. PLoS One. 2021 Feb 23;16(2):e0247275. doi: 10.1371/journal.pone.0247275. eCollection 2021.

BACKGROUND: The aim of this secondary analysis of the TESEO cohort is to identify, early in the course of treatment with tocilizumab, factors associated with the risk of progressing to mechanical ventilation and death and develop a risk score to estimate the risk of this outcome according to patients' profile.

METHODS: Patients with COVID-19 severe pneumonia receiving standard of care + tocilizumab who were alive and free from mechanical ventilation at day 6 after treatment initiation were included in this retrospective, multicenter cohort study. Multivariable logistic regression models were built to identify predictors of mechanical ventilation or death by day-28 from treatment initiation and ß-coefficients were used to develop a risk score. Secondary outcome was mortality. Patients with the same inclusion criteria as the derivation cohort from 3 independent hospitals were used as validation cohort.

RESULTS: 266 patients treated with tocilizumab were included. By day 28 of hospital follow-up post treatment initiation, 40 (15%) underwent mechanical ventilation or died [26 (10%)]. At multivariable analysis, sex, day-4 PaO2/FiO2 ratio, platelets and CRP were independently associated with the risk of developing the study outcomes and were used to generate the proposed risk score. The accuracy of the score in AUC was 0.80 and 0.70 in internal validation and test for the composite endpoint and 0.92 and 0.69 for death, respectively.

CONCLUSIONS: Our score could assist clinicians in identifying, early after tocilizumab administration, patients who are likely to progress to mechanical ventilation or death, so that they could be selected for eventual rescue therapies.

Discipline / Specialty Area Score
Infectious Disease
Intensivist/Critical Care
Hospital Doctor/Hospitalists
Internal Medicine
Comments from MORE raters

Hospital Doctor/Hospitalists rater

This is an interesting study utilising a scoring system to predict the progression of COVID-19 to mechanical ventilation post Tocilizumab.

Infectious Disease rater

This secondary analysis of the TESEO study looks at predictors of outcome in 266 patients treated with tocilizumab at 3 hospitals in one region of Italy. It's possibly useful to practitioners trying to determine which patients might benefit from this expensive and not particularly effective therapy.

Intensivist/Critical Care rater

The variables attached to poor outcomes are not compared to people without tocilizumab. These variables also have the same poor outcome in COVID-19 pneumonia.

Internal Medicine rater

The aim of this study was to identify early predictors of Tozilizumab failure in order to develop a risk score to predict mechanical ventilation of Covid-19 treatment patients. The problem is that the starting premise is failing, due that the beneficial effects of tozilizumab has not been definitely proved yet, so the prediction score for it effects makes no sense to many doctors.

Respirology/Pulmonology rater

The work is interesting, with a good design, and results that can have an important applicability.