C-reactive protein cut-off for early tocilizumab and dexamethasone prescription in hospitalized patients with COVID-19
Authors: Camon Ana M. , Alonso Rodrigo , Muñoz Francisco J. , Cardozo Celia , Bernal-Maurandi Javier , Albiach Laia , Agüero Daiana , Marcos M. Angeles , Ambrosioni Juan , Bodro Marta , Chumbita Mariana , De la Mora Lorena , Garcia-Pouton Nicole , Dueñas Gerard , Hernandez-Meneses Marta , Inciarte Alexy , Cuesta Genoveva , Meira Fernanda , Morata Laura , Puerta-Alcalde Pedro , Rico Verónica , Herrera Sabina , Tuset Montse , Castro Pedro , Prieto-González Sergio , Almuedo Alex , Muñoz José , Mensa Josep , Sanjuan Gemma , Nicolas J. M. , Del Rio Ana , Vila Jordi , García Felipe , Martínez José Antonio , Garcia-Vidal Carolina , Soriano Alex ,   Hospital Clinic of Barcelona COVID-19 Research Group,   Infectious Diseases’ Research Group, Blanco J. L. , Mallolas J. , Martínez E. , Martínez M. , Miró J. M. , Moreno A. , Solá M. , Ugarte A. , Gonzalez-Cordón Ana , Laguno Montse , Leal Lorna , Rojas John , Torres Berta ,   all the staff members,   Medical Intensive Care Unit, Fernandez S. , Tellez A. , Fuentes F. , Ayala M. , Sancho E. ,   Department of International Health, Campubri D. , de Alba M. T. , Fernandez M. , Ferrer E. , Grau B. , Marti H. , Muelas M. , Pinazo M. J. , Rodriguez N. , Roldan M. , Subira C. , Vera I. , Williams N. , Almuedo-Riera A. ,   all the staff members,   Department of Internal Medicine, Aldea A. , Camafort M. , Calvo J. , Capdevila A. , Cardellach F. , Carbonell I. , Coloma E. , Foncillas A. , Estruch R. , Feliu M. , Fernández-Solá J. , Fuertes I. , Gabara C. , Grafia I. , Ladino A. , López-Alfaro R. , López-Soto A. , Macaya I. , Masanés F. , Matas A. , Navarro M. , Hernández J. Marco- , Miguel L. , Milisenda J. C. , Moreno P. , Naval J. , Nicolás D. , Oberoi H. , Padrosa J. , Pellicé M. , Ribot J. , Rodríguez-Núnez O. , Sacanella E. , Seguí F. , Sierra C. , Tomé A. , Torres M. , Ventosa H. , Zamora-Martínez C. ,   all the staff members,   Department of Microbiology, Almela M. , Alvarez M. , Bosch J. , Costa J. , Cuesta G. , Fidalgo B. , Gonzàlez J. , Marco F. , Narvaez S. , Pitart C. , Rubio E. , Vergara A. , Valls M. E. , Zboromyrska Y. ,   all the staff members,   Department of Farmacy, López E. ,   all the staff members
Published: March 2022

Dexamethasone and tocilizumab have been associated with reduction in mortality, however, the beneficial effect is not for all patients and the impact on viral replication is not well defined. We hypostatized that C-reactive protein (CRP) could help in the identification of patients requiring anti-inflammatory therapy. Patients admitted for > 48 h in our hospital for a confirmed or suspected infection by SARS-CoV-2 from February 2020 to February 2021 were retrospectively evaluated. The primary outcome was mortality at 30 days. Demographics and the most relevant variables related with the outcome were included. CRP was stratified by percentiles. Univariate and multivariate analysis were performed. A total of 3218 patients were included with a median (IQR) age of 66 (74–78) years and 58.9% were males. The rate of intensive care unit admission was 24.4% and the 30-day mortality rate was 11.8%. Within the first 5 days from admission, 1018 (31.7%) patients received dexamethasone and 549 tocilizumab (17.1%). The crude analysis showed a mortality reduction in patients receiving dexamethasone when CRP was > 13.75 mg/dL and > 3.5 mg/dL for those receiving tocilizumab. Multivariate analysis identified the interaction of CRP > 13.75 mg/dL with dexamethasone (OR 0.57; CI 95% 0.37–0.89, P = 0014) and CRP > 3.5 mg/dL with tocilizumab (0.65; CI95%:0.44–0.95, P = 0.029) as independent predictors of mortality. Our results suggest that dexamethasone and tocilizumab are associated with a reduction in mortality when prescribed to patients with a certain inflammatory activity assessed by C-reactive protein.