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Tocilizumab in COVID-19: The Cerrahpaşa-PREDICT score
Ahmet Emre Eşkazan1, İlker İnanç Balkan2, Kaan Can Demirbaş3
1Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
Insights
Tocilizumab improved outcomes for severe COVID-19 patients with cytokine release syndrome. The Cerrahpaşa-PREDICT score aids in predicting mortality, enabling timely interventions for better patient management.
Area of Science:
- Infectious Diseases
- Immunology
- Critical Care Medicine
Background:
- Cytokine release syndrome (CRS) is a major cause of mortality in severe COVID-19.
- Tocilizumab, an IL-6 receptor inhibitor, is a potential treatment for CRS in SARS-CoV-2 infection.
Purpose of the Study:
- To evaluate the outcomes of COVID-19 patients treated with tocilizumab.
- To develop and validate the Cerrahpaşa-PREDICT score for predicting 28-day mortality in these patients.
Main Methods:
- A single-center retrospective study of 87 COVID-19 patients treated with tocilizumab.
- Development of the Cerrahpaşa-PREDICT score using clinical and laboratory parameters.
Main Results:
- Tocilizumab administration improved clinical and laboratory parameters in COVID-19 patients.
- The 28-day mortality rate was 16.1% in patients receiving tocilizumab.
- The Cerrahpaşa-PREDICT score demonstrated high positive (94.5%) and negative (92.9%) predictive values for 28-day mortality.
Conclusions:
- Early tocilizumab administration in severe COVID-19 may lead to favorable outcomes.
- The Cerrahpaşa-PREDICT score is a practical tool for estimating mortality risk in COVID-19 patients treated with tocilizumab.
- Close monitoring and risk stratification can facilitate timely therapeutic decisions.
Background:
Cytokine release syndrome (CRS), characterized by overproduction of proinflammatory cytokines in the course of severe coronavirus disease 2019 (COVID-19), has been suggested as the major cause of mortality. Tocilizumab, a recombinant humanized monoclonal antibody against human IL-6 receptor, poses a therapeutic option for the treatment of CRS leading to severe acute respiratory syndrome in coronavirus-2 (SARS-CoV-2) infection.
Methods:
We performed a single-center retrospective study to reveal the outcome of COVID-19 patients on tocilizumab and proposed "the Cerrahpaşa-PREDICT score", a new clinical scoring system using clinical and laboratory parameters that would help predicting the 28-day mortality of COVID-19 patients receiving tocilizumab.
Results:
Eighty-seven patients (median age: 59 years) were included of whom 75.8% were male. Tocilizumab use significantly improved clinical and laboratory parameters. The 28-day mortality rate on tocilizumab was 16.1%. The Cerrahpaşa-PREDICT score, consisting of platelet counts, procalcitonin, D-dimer levels, SO2R and the time from symptom onset to tocilizumab administration had a positive predictive value of 94.5% and negative predictive value of 92.9% for anticipating 28-day mortality.
Conclusions:
Severe COVID-19 should closely be monitored for the signs of hyperinflammation. We showed that administration of tocilizumab early in the course of the disease (prior to ICU admission) resulted in a favorable outcome. Close monitoring usually aids identifying patients who would benefit from tocilizumab. In this regard, the Cerrahpaşa-PREDICT score might serve as a practical tool for estimating the 28-day mortality in COVID-19 patients who received tocilizumab and would facilitate timely recognition of fatal cases to be evaluated for other therapeutic options.
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