Evidence map›Paper›PMID 36851508›Full record

Observational studyViruses2023

Do All Critically Ill Patients with COVID-19 Disease Benefit from Adding Tocilizumab to Glucocorticoids? A Retrospective Cohort Study.

Cristina Mussini, Alessandro Cozzi-Lepri, Marianna Meschiari, Erica Franceschini, Giulia Burastero, Matteo Faltoni, Giacomo Franceschi, Vittorio Iadisernia, Sara Volpi, Andrea Dessilani and 15 more

Open access · goldAbstract readObservational Study
In one paragraph

Observational study in Viruses, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
1.0field-weighted citation impact, top 28% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 5 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

25 authors at 3 institutions in 2 countries.

Cristina MussiniDepartment of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, 41124 Modena, Italy.
Alessandro Cozzi-LepriCentre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, WC1E 6BT, UK.
Marianna MeschiariDepartment of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, 41124 Modena, Italy.ORCID 0000-0002-1254-9995
Erica FranceschiniDepartment of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, 41124 Modena, Italy.ORCID 0000-0001-6922-5759
Giulia BurasteroDepartment of Surgical, Medical, Dental and Morphological Sciences University of Modena and Reggio Emilia, 41124 Modena, Italy.
Matteo FaltoniDepartment of Surgical, Medical, Dental and Morphological Sciences University of Modena and Reggio Emilia, 41124 Modena, Italy.
Giacomo FranceschiDepartment of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, 41124 Modena, Italy.ORCID 0000-0003-0047-6634
Vittorio IadiserniaDepartment of Surgical, Medical, Dental and Morphological Sciences University of Modena and Reggio Emilia, 41124 Modena, Italy.
Sara VolpiDepartment of Surgical, Medical, Dental and Morphological Sciences University of Modena and Reggio Emilia, 41124 Modena, Italy.
Andrea DessilaniDepartment of Surgical, Medical, Dental and Morphological Sciences University of Modena and Reggio Emilia, 41124 Modena, Italy.
Licia GozziDepartment of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, 41124 Modena, Italy.ORCID 0000-0002-9510-3939
Jacopo ContiDepartment of Surgical, Medical, Dental and Morphological Sciences University of Modena and Reggio Emilia, 41124 Modena, Italy.
Martina Del MonteDepartment of Surgical, Medical, Dental and Morphological Sciences University of Modena and Reggio Emilia, 41124 Modena, Italy.
Jovana MilicDepartment of Surgical, Medical, Dental and Morphological Sciences University of Modena and Reggio Emilia, 41124 Modena, Italy.
Vanni BorghiDepartment of Surgical, Medical, Dental and Morphological Sciences University of Modena and Reggio Emilia, 41124 Modena, Italy.
Roberto TonelliClinical and Experimental Medicine PhD Program, Department of Biomedical and Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, 41124 Modena, Italy.ORCID 0000-0002-6202-0758
Lucio BrugioniInternal Medicine Department, Azienda Ospedaliero-Universitaria Policlinico of Modena, 41124 Modena, Italy.
Elisa RomagnoliInternal Medicine Department, Azienda Ospedaliero-Universitaria Policlinico of Modena, 41124 Modena, Italy.ORCID 0000-0002-4536-2406
Antonello PietrangeloDepartment of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy.
Elena CorradiniDepartment of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy.ORCID 0000-0001-9477-2164
Massimo GirardisDepartment of Surgical, Medical, Dental and Morphological Sciences University of Modena and Reggio Emilia, 41124 Modena, Italy.ORCID 0000-0002-2453-0829
Stefano BusaniDepartment of Surgical, Medical, Dental and Morphological Sciences University of Modena and Reggio Emilia, 41124 Modena, Italy.
Andrea CossarizzaDepartment of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy.
Enrico CliniRespiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, 41124 Modena, Italy.ORCID 0000-0002-1515-5094
Giovanni GuaraldiDepartment of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, 41124 Modena, Italy.
University of Modena and Reggio Emilia · ITAzienda Ospedaliero-Universitaria di Modena · ITNational Institute for Health Research · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTreatment guidelines recommend the tocilizumab use in patients with a CRP of >7.5 mg/dL. We aimed to estimate the causal effect of glucocorticoids + tocilizumab on mortality overall and after stratification for PaO

methodsThis was an observational cohort study of patients with severe COVID-19 pneumonia. The primary endpoint was day 28 mortality. Survival analysis was conducted to estimate the conditional and average causal effect of glucocorticoids + tocilizumab vs. glucocorticoids alone using Kaplan-Meier curves and Cox regression models with a time-varying variable for the intervention. The hypothesis of the existence of effect measure modification by CRP and PaO

resultsIn total, 992 patients, median age 69 years, 72.9% males, 597 (60.2%) treated with monotherapy, and 395 (31.8%), adding tocilizumab upon respiratory deterioration, were included. At BL, the two groups differed for median values of CRP (6 vs. 7 mg/dL;

conclusionsOur data confirm that glucocorticoids + tocilizumab vs. glucocorticoids alone confers a survival benefit only in patients with a CRP > 7.5 mg/dL prior to treatment initiation and the largest effect for a CRP > 15 mg/dL. Large randomized studies are needed to establish an exact cut-off for clinical use.

Indexed as

COVID-19GlucocorticoidsAgedAntibodies, Monoclonal, HumanizedCOVID-19 Drug TreatmentCritical IllnessFemaleHumansMaleRetrospective StudiesAntibodies, Monoclonal, HumanizedGlucocorticoidstocilizumabCOVID-19glucocorticoidstocilizumab

Identifiers

PMID36851508
PMCPMC9967307
OpenAlexW4317625856

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.