Abstract

Interleukin-6 receptor antagonists (IL-6RAs) and steroids are emerging immunomodulatory therapies for severe and critical coronavirus disease (COVID-19). In this preliminary report, we aim to describe the epidemiology, clinical characteristics, and outcomes of adult critically ill COVID-19 patients,
Aim: to evaluate whether the immunomodulation with an IL-6 antagonist is associated with an improved hemostasis in patients with COVID-19 as measured by viscoelastic tests.
Materials and methods: This prospective study was conducted in Kirkuk city – Iraq, from the first of March 2021 until the end of June 2021. The study included 50 patients from both sexes with age above (18-60) years. Clinical and laboratory parameters, such as blood pressure (systolic, diastolic), heart rate, peripheral capillary oxygen saturation (SpO2), respiratory rate, body temperature, disease severity scores, ventilation parameters, blood gas parameters, VHA results will be recorded at set time intervals (see later). All the medication that the patient has taken during the study period will be noted. Blood culture samples will also be taken when indicated to exclude superinfection thus ensuring that these will not influence the results of the study. Blood sample was collected by vein puncture from each subject enrolled in this study .  for determination  of ALT, AST, LDH , S. creatinine, BUN , TSB and  S . Albumin . The primary outcome is the change of the Lab parameters measured   before IL-6 antagonist and  2 weeks after immunomodulation therapy of IL-6 antagonist. As and the effect of it are relatively shortly seen in inflammatory parameters after administration, we decided to use the parameters. In addition, the study will investigate the following secondary outcomes
Results: The study revealed that, the risk of covid-19 infection increased with age as elderly was most affected. The study showed that 36.36%  of covid-19 smoker cases were with  severe infection, 27.27%  were with critical  infection and 18.18% were with moderate infection (P<0.001). The study demonstrated that,   74% (37 0f 50) of covid-19 infected patients improved after two weeks of infection 22% had complication of infection while unfortunately, 4%  (3 of 50) died due to complications of Covid-19 infection.The study showed  that random  blood sugar was relatively high in COVID-19 patients  (213.4±60.14) mg/dL and  then decreased slightly two weeks after treatment (174.9±49.9) mg/dL  compared to the control group  (105.7  ±15.9) (P:0.001), andthe highest rate of D-Dimer testing was recorded in  COVID-19 patients  (760.3±187).  8 ng/ml  and then decreased slightly two weeks after treatment (167.3±657.9 ng/ml compared to the control group  (105.7±15.9). The study also showed that the highest rate of lactate dehydrogenase (LDH) was recorded in COVID-19 patients  (  348.6±65.7) U/L  and then relatively decreased after two weeks of treatment  (315.3±60.4) U/L  compared to the control group (96.7±23.9)  U/L.  The study showed that the  highest levels of ferritin were recorded in COVID-19 patients  (390.4±83.5) ng/ml and then relatively low two weeks after treatment  (319.5±81). 3)ng/ml, compared to the control group (96.7±23.9)ng/ml. The study also revealed that the  highest levels of urea, creatinine and ALT were recorded in patients with  Covid- and then its rate decreased relatively two weeks after receiving treatment, compared  to a group. While  the study revealed that the rate of albumin  was significantly low in COVID-19 patients  and then  increased relatively after two weeks of receiving compared to the control group who were characterized by a normal rate of albumin. TCZ appears to be an effective treatment option in COVID-19 patients with a risk of cytokine storms. And for these critically ill patients with elevated IL-6, the repeated dose of the TCZ is recommended