Baricitinib and Pulse Steroids Combination Treatment in Hyperinflammatory COVID-19: A Rheumatological Approach in the Intensive Care Unit
Abstract
:1. Introduction
2. Results
3. Discussion
4. Materials and Methods
4.1. Participants
- SARS-CoV-2 infection confirmed by PCR analysis on nasopharyngeal swab;
- CT-proven SARS-CoV-2 pneumonia;
- Need for invasive or non-invasive ventilatory support for P/F < 200 at baseline;
- Absence of clinical and/or laboratory signs of other concomitant infections at the time of admission in ICU (enrollment).
4.2. Clinical and Laboratory Parameters
4.3. CT Scan Description
4.4. Therapeutic Approach and Study Design
4.5. Study Objectives
4.6. Statistical Analysis
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
ARDS | Acute Respiratory Distress Syndrome |
ASS | Antisynthetase Syndrome |
COVID-19 | Coronavirus Disease 2019 |
ECMO | Extracorporeal Membrane Oxygenation |
GC | Glucocorticoids |
GGO | Ground Glass Opacities |
HI | Hyperinflammatory |
ICU | Intensive Care Unit |
IFN | Interferon |
IIM | Inflammatory Myopathies |
RP-ILD | Rapidly-Progressive Interstitial Lung Diseases |
SARS-CoV-2 | Severe Acute Respiratory Syndrome Coronavirus-2 |
SoC | Standard of Care |
6MP | 6-methylprednisolone |
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Standard of Care Group (n° = 104) | Rheuma Group (n° = 142) | |
---|---|---|
Age, years (mean ± SD) | 66.8 ± 10.4 | 64 ± 11.3 |
Sex, n° (%) | ||
Male | 70 (67%) | 90 (63%) |
Female | 34 (33%) | 52 (37%) |
Pre-existing comorbidities, n° (%) | ||
COPD 1 | 18 (17%) | 29 (20%) |
Obesity | 11 (10%) | 25 (17%) |
CHD 2 | 9 (8%) | 17 (11%) |
Hypertension | 25 (24%) | 31 (22%) |
Inflammatory markers, (mean ± SD) | ||
C-reactive protein, mg/dL | 10.3 ± 8.7 | 11.6 ± 6.6 |
Ferritin, ng/mL | 1155 ± 1059 | 1294 ± 995 |
Fibrinogen, mg/dL | 568 ± 200 | 580 ± 130 |
Lactate dehydrogenase, U/L | 395 ± 165 | 382 ± 130 |
Lymphocytes/mcL | 810 ± 240 | 480 ± 99 |
Max d-dimer, mg/L | 1410 ± 749 | 3507 ± 3044 |
P/F 3 Ratio, (mean ± SD) | 203 ± 122 | 211 ± 143 |
Time from first symptom to ICU 4, days (mean ± SD) | 15.0 ± 4.2 | 9.5 ± 4.5 |
Standard of Care Group (n° = 104) | Rheuma Group (n° = 142) | p Value | |
---|---|---|---|
Intra ICU 1 death rate, n° (%) | 42/104 (40.4%) | 22/142 (15.5%) | <0.001 |
Duration of ICU 1 hospitalization, days (mean ± SD) | 14.6 ± 9.6 | 14.5 ± 8.1 | ns |
Inflammatory markers after 1 week (mean ± SD) | |||
C-reactive protein, mg/dL | 6.14 ± 7.3 | 2.03 ± 2.75 | <0.001 |
Ferritin, ng/mL | 1075 ± 856 | 888 ± 619 | <0.05 |
Fibrinogen, mg/dL | 453 ± 172 | 358 ± 118 | <0.001 |
Survivors (n° = 104, 84%) | Deceased (n° = 22, 16%) | p Value | |
---|---|---|---|
Age, years (mean ± SD) | 62.9 ± 11.5 | 70.9 ± 7.1 | <0.01 |
Sex, n° (%) | |||
Male | 76 (63%) | 14 (63%) | ns |
Female | 28 (27%) | 8 (27%) | ns |
Inflammatory markers at baseline (mean ± SD) | |||
C-reactive protein, mg/dL | 6.27 ± 2.55 | 15.67 ± 7.59 | ns |
Ferritin, ng/mL | 744 ± 409 | 737 ± 205 | ns |
Fibrinogen, mg/dL | 590 ± 119 | 577 ± 132 | ns |
Lactate dehydrogenase, U/L | 375 ± 44 | 420 ± 58 | ns |
Procalcitonin ng/mL | 0.09 ± 0.04 | 0.13 ± 0.02 | ns |
Baseline TSS 1 | 11.8 ± 3.2 | 12.6 ± 4.3 | ns |
Inflammatory markers after one week (mean ± SD) | |||
C-reactive protein, mg/dL | 1.47 ± 1.76 | 5.31 ± 4.60 | <0.001 |
Ferritin, ng/mL | 842 ± 554 | 1140 ± 871 | <0.05 |
Fibrinogen, mg/dL | 344 ± 100 | 441 ± 169 | <0.001 |
Lactate dehydrogenase, U/L | 375 ± 44 | 420 ± 58 | ns |
Duration of symptoms before hospitalization, days (mean ± SD) | 8.2 ± 3.1 | 6.5 ± 2.5 | ns |
Time between hospitalization and treatment start, days (mean ± SD) | 5.1 ± 4.2 | 8.2 ± 6.8 | <0.01 |
Total duration of ICU 2 hospitalization, days (mean ± SD) | 13.5 ± 3.5 | 17.3 ± 8.4 | ns |
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Ferro, F.; La Rocca, G.; Elefante, E.; Italiano, N.; Moretti, M.; Talarico, R.; Pelati, E.; Valentini, K.; Baldini, C.; Mozzo, R.; et al. Baricitinib and Pulse Steroids Combination Treatment in Hyperinflammatory COVID-19: A Rheumatological Approach in the Intensive Care Unit. Int. J. Mol. Sci. 2024, 25, 7273. https://doi.org/10.3390/ijms25137273
Ferro F, La Rocca G, Elefante E, Italiano N, Moretti M, Talarico R, Pelati E, Valentini K, Baldini C, Mozzo R, et al. Baricitinib and Pulse Steroids Combination Treatment in Hyperinflammatory COVID-19: A Rheumatological Approach in the Intensive Care Unit. International Journal of Molecular Sciences. 2024; 25(13):7273. https://doi.org/10.3390/ijms25137273
Chicago/Turabian StyleFerro, Francesco, Gaetano La Rocca, Elena Elefante, Nazzareno Italiano, Michele Moretti, Rosaria Talarico, Erika Pelati, Katia Valentini, Chiara Baldini, Roberto Mozzo, and et al. 2024. "Baricitinib and Pulse Steroids Combination Treatment in Hyperinflammatory COVID-19: A Rheumatological Approach in the Intensive Care Unit" International Journal of Molecular Sciences 25, no. 13: 7273. https://doi.org/10.3390/ijms25137273