The Uticaj tocilizumaba na tok i ishod lečenja pacijenata sa COVID-19 pneumonijom - iskustvo bolnice sekundarnog nivoa

  • Sladjana M Pavic Opsta bolnica Uzice, Odeljenje ya infektivne i tropske bolesti
  • Radomir Slović Jedinica intenzivne nege, Opšta bolnica Užice, Republika Srbija
  • Aleksa Novković Centar za nuklearnu medicinu, UKC Srbije, Beograd, Republika Srbija
  • Aleksandra Pavić Centar za radiologiju, UKC Srbije, Beograd, Republika Srbija
Ključne reči: tocilizumab, COVID-19 pneumonija, klinicki tok, prediktori letaliteta

Sažetak


Uvod: Važnu ulogu u progresiji COVID-19 pneumonije ima IL-6. Za blokadu njegove aktivnosti koristi se monoklonsko antitelo tocilizumab.

Cilj istraživanja je bio ispitivanje uticaja tocilizumaba na klinički tok, laboratorijske parametre, radiografske promene kod pacijenata sa COVID-19 pneumonijom i odredjivanje prediktorna letalnog ishoda.

Metod: Retrogradno su ispitani podaci uzeti 340 pacijenata sa COVID-19 pneumonijom lečenih tocilizumabom. Podaci su uzeti na dan primene tocilizumaba i  pet dana nakon toga. Ispitivani su pol, uzrast, klinički tok i ishod bolesti, prisustvo komorbiditeta, nastanak bolničkih infekcija, metod oksigenacije i radiografske promene. Parametri su upoređivani u odnosu na smrtnost. Statistička obrada izvršena je pomoću programa SPSS, verzija 25.0.

Rezultati: Prosečna starost pacijenata iznosila je 66,22 ± 11,37 godina, a 66,4% su činili muškarci. Komorbiditete je imalo 65,4% pacijenata, najčešće arterijsku hipertenziju (56,2%). Bolničke infekcije registrovane su kod 8,5% pacijenata, pri čemu je bakterijska pneumonija bila najčešća (34,5%). Neinvazivna oksigenoterapija primenjena je kod 64,1% bolesnika, dok je 24% zahtevalo mehaničku ventilaciju. Pre primene tocilizumaba 23,8% pacijenata imalo je R/F indeks <200, a nakon terapije 15,9%. Radiografski skor (CXR-SS) pokazao je teške promene kod 71,5%, a veoma teške kod 27,1% pacijenata. Smrtnost je iznosila 21,8%, pri čemu je 78,3% preminulih bilo starije od 65 godina. Veoma težak CXR-SS imalo je 75,7% preminulih.

Zaključak: Tocilizumab je doveo do poboljšanja respiratorne funkcije i smanjenja inflamatornih biohemijskih parametara. Starost iznad 65 godina, prisustvo komorbiditeta i bolničkih infekcija povezani su sa većom smrtnošću, dok su izražene radiografske promene i potreba za mehaničkom ventilacijom glavni prediktori smrtnog ishoda.

Biografija autora

Sladjana M Pavic, Opsta bolnica Uzice, Odeljenje ya infektivne i tropske bolesti

Prim. dr sc. med. Sladjana Pavic, specijalista za infektivne i tropske bolesti;

nacelnica odeljenja za infektivne i tropske bolesti OB Uzice;

predsednica Etickog odbora ZC Uzice;

clan Saveta direktora ZC Uzice;

zamenik predsednika Komisije za bolnicke infekcije OB Uzice i clan Komisije za bolnicke infelcije ZC Uzice

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Objavljeno
2026/07/04
Broj časopisa
Vol. 31 Br. 100 (26)
Rubrika
Originalni naučni članak