Association Between Inflammatory Markers, Comorbidities, and Mortality in COVID-19 Patients Treated With Tocilizumab

Tocilizumab, an interleukin-6 receptor antagonist, has been widely used in the management of severe COVID-19 cases, but its clinical outcomes have been variable. A retrospective cohort including 113 hospitalized adult patients with confirmed COVID-19 treated with tocilizumab between March and October 2021 at a private hospital in southern Brazil. Demographic, clinical, and laboratory variables were collected at four time points: admission, 72 h before tocilizumab administration, 72 h after, and at hospital discharge or death. The median age was significantly higher among non-survivors (73.0 vs. 58.5 years; p < 0.01). Cardiovascular, metabolic, pulmonary, and neoplastic comorbidities negatively impacted clinical outcomes. These patients also showed persistent elevation of inflammatory markers and organ dysfunction indicators, such as d-dimer, urea, and BNP. Concomitant use of corticosteroids was associated with improved survival (p = 0.04). Age, comorbidities, and persistent elevation of inflammatory markers were associated with worse prognosis in patients treated with tocilizumab. Concomitant use of corticosteroids demonstrated a potential benefit, suggesting a synergistic effect between the therapies. These findings underscore the importance of laboratory monitoring and individualized therapeutic approaches in severe COVID-19.