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Published on: February 17, 2022
Clinical Value of Tocilizumab in Reducing Mortality in Refractory Septic Shock in Children with Hematologic and
En-Pei Lee1,2, Jainn-Jim Lin1,2, Shih-Hsiang Chen2,3
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan 33305, Taiwan.
Insights
Tocilizumab significantly reduced mortality and intensive care unit stay in children with refractory septic shock. This interleukin-6 receptor antibody shows promise in treating pediatric septic shock by mitigating inflammation.
Area of Science:
- Pediatric critical care medicine
- Immunology
- Pharmacology
Background:
- Pediatric sepsis is a leading cause of child mortality and morbidity.
- Elevated Interleukin-6 (IL-6) levels post-infection can lead to multi-organ damage.
- Tocilizumab, an IL-6 receptor antibody, is investigated for its potential in treating pediatric septic shock.
Purpose of the Study:
- To evaluate the efficacy of tocilizumab in children experiencing refractory septic shock.
- To assess the impact of tocilizumab on mortality, morbidity, and length of pediatric intensive care unit (PICU) stay.
Main Methods:
- A retrospective cohort study included 54 children with septic shock admitted to the PICU (2018-2024).
- Tocilizumab was administered within 24 hours to patients with high IL-6 levels and refractory septic shock.
- Outcomes were analyzed comparing patients who received tocilizumab versus those who did not.
Main Results:
- Tocilizumab treatment was associated with significantly lower 28-day mortality (14.2% vs. 54.5%, p=0.03) and shorter PICU stays.
- In non-hematologic septic shock, tocilizumab reduced mortality from 50% to 0% (p=0.006).
- No adverse events like secondary infections or liver impairment were observed.
Conclusions:
- Tocilizumab may effectively reduce systemic inflammation and improve outcomes in pediatric refractory septic shock.
- Further prospective studies are needed to confirm these findings and develop treatment guidelines.
Background:
Pediatric sepsis remains the main cause of morbidity and mortality among children. Interleukin (IL)-6 is usually produced after infection, and elevated IL-6 levels may cause multisystemic damage. This study aimed to evaluate the effect of tocilizumab, an IL-6 receptor antibody, on children with septic shock.
Methods:
We conducted a retrospective cohort study of children diagnosed with septic shock and admitted to the pediatric intensive care unit (PICU) between 2018 and 2024. Tocilizumab was administered within 24 h to patients with high IL-6 levels who developed refractory septic shock. Outcomes, including 28-day mortality, morbidity, length of PICU stay, and shock duration, were analyzed between septic children with different etiologies and differed treatments.
Results:
Fifty-four children with refractory septic shock were included. Patients treated with tocilizumab (n = 21) showed improved outcomes compared to those without tocilizumab (n = 33), including shorter PICU stays and lower mortality rates (14.2% vs. 54.5%, p = 0.03). Subgroup analysis revealed that in the non-hematologic group, tocilizumab-treated patients had a 0% mortality rate compared to 50% in untreated patients (p = 0.006). In the hematologic group, tocilizumab-treated patients exhibited a 27.2% mortality rate compared to 61.5% in untreated patients (p = 0.09). Trends in IL-6 levels (D1 to D7) were significantly higher in non-survivors compared to survivors and in patients with hematological malignancies compared to those without. No adverse events, including secondary infections or long-term liver impairment, were observed.
Conclusions:
Tocilizumab appears to mitigate systemic inflammation and improve outcomes in children with refractory septic shock and elevated IL-6 levels. Further prospective studies are warranted to confirm these findings and establish treatment guidelines.
