![]() ![]() Thirty-nine studies with 15,531 patients (3657 cases versus 11,874 controls) were identified. The impact of tocilizumab and concomitant corticosteroid therapy or tocilizumab alone versus standard of care (SOC) on the death rate, need for mechanical ventilation, ICU admission and bacterial infections were assessed. Subgroup analyses and meta-regressions were performed. We performed a systematic review and meta-analysis of case-control studies utilising tocilizumab in COVID-19 on different databases (PubMed/MEDLINE/Scopus) and preprint servers (medRxiv and SSRN) from inception until 20 July 2020 (PROSPERO CRD42020195690). Tocilizumab is an anti-IL-6 therapy widely adopted in the management of the so-called "cytokine storm" related to SARS-CoV-2 virus infection, but its effectiveness, use in relation to concomitant corticosteroid therapy and safety were unproven despite widespread use in numerous studies, mostly open label at the start of the pandemic. v7 of this living review article has been published in _Addiction_ However, it is uncertain whether these associations are causal. CONCLUSIONS: Compared with never smokers, current smokers appear to be at reduced risk of SARS-CoV-2 infection while former smokers appear to be at increased risk of hospitalisation, greater disease severity and mortality from COVID-19. Data for current smokers on hospitalisation, disease severity and mortality were inconclusive (RR = 1.1, 95% CrI = 0.99-1.21, τ = 0.15 RR 1.26, 95% CrI = 0.92-1.73, τ = 0.32 RR = 1.12, 95% CrI = 0.84-1.47, τ = 0.42, respectively) but favoured there being no important associations with hospitalisation and mortality (49% and 56% probability of RR ≥1.1, respectively) and a small but important association with disease severity (83% probability of RR ≥1.1). Data for former smokers were inconclusive (RR = 1.03, 95% CrI = 0.95-1.11, τ = 0.17) but favoured there being no important association (4% probability of RR ≥1.1). Current compared with never smokers were at reduced risk of SARS-CoV-2 infection (RR = 0.71, 95% Credible Interval (CrI) = 0.61-0.82, τ = 0.34). Recorded smoking prevalence among people with COVID-19 was generally lower than national prevalence. 121 studies (29.9%) reported current, former and never smoking status with the remainder using broader categories. FINDINGS: v11 (searches up to ) included 405 studies with 62 ‘good’ and ‘fair’ quality studies included in unadjusted meta-analyses. MEASUREMENTS: Outcomes were SARS-CoV-2 infection, hospitalisation, disease severity and mortality stratified by smoking status. PARTICIPANTS: Adults who received a SARS-CoV-2 test or a COVID-19 diagnosis. Published articles and pre-prints were identified via MEDLINE and medRxiv. DESIGN: Living rapid review of observational and experimental studies with random-effects hierarchical Bayesian meta-analyses. A transition from an early intubation strategy to aggressive utilization of high flow nasal cannula and noninvasive ventilation(i.e BiPAP) was successful in freeing up ICU resources.ĪIMS: To estimate the association of smoking status with rates of i) infection, ii) hospitalisation, iii) disease severity, and iv) mortality from SARS-CoV-2/COVID-19 disease. The latter two groups were significantly more ill than the untreated group. Survival of those treated with hydroxychloroquine-azithromycin was 92%, compared to 86% of those treated with hydroxychloroquine alone. Survival was 93% in those not receiving any antivirals. Overall survival of the COVID-19 patients was 88%, 77% in the critically ill, 59% of those mechanically ventilated and 33% of those requiring new dialysis. Fever, cough, dyspnea, nausea, emesis, diarrhea, headache and myalgias were significantly more common in that group, as was an elevated CRP, LDH, serum ferritin and transaminases. Cardiovascular disease was a significant comorbidity in the PCR+ group. Ninety-one patients were SARS-CoV2 PCR+ with 63% being male and a median age of 60. A retrospective, descriptive study of all patients tested for SARS-CoV2 on admission for illness to a community hospital in Iowa from 3/21/20 thru 6/14/20 consisted of evaluation as to demographics, presentation and hospital course. ![]()
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