Predictors of Mortality in Severe and Critical COVID-19 Patients Receiving High Dose Intravenous Anakinra

Objective: In this study, we aim to evaluate the predictive factors associated with mortality in patients with severe and critical COVID-19 receiving high dose intravenous anakinra. Methods: This is an observational retrospective study was conducted at a tertiary referral center between 01.09.2021 and 01.02.2022 in Turkey. COVID-19 disease severity was evaluated according to National Institute of Health (NIH) severity scale. Inflammatory state of the patients was calculated according to COVID hyperinflammatory syndrome (cHIS) score. Clinical (patients characteristics, disease severity, inflammatory state) and laboratory parameters such as lymphocyte count, CRP, LDH, ferritin and d-dimer levels were compared in patients had mortality and those had not. Results: Data of 148 patients (n=78; 53% male) were analyzed. Mean±standard deviation (SD) patient age was 66.8±17 years and median (interquartile of range; IQR) duration of hospitalization was 11 (12) days. In this cohort, 57 patients (38.5%) severe, 91 patients (61.5%) had critical disease and mean±SD cHIS score was 3.4±1.2. Overall, 56 patients (37.8%) died during the follow-up and ICU admission was in 60 patients (40.5%) and intubation was in 54 patients (36.5%). Conclusion: In our study mortality was developed in third of anakinra receiving severe and critical ill COVID-19 patients. Mortality was independently associated with advanced age, critical illness and higher cHIS score reflecting higher inflammatory burden. Furthermore, highest levels of CRP, LDH, ferritin, D-dimer and higher cHIS score predict higher mortality in patients with COVID-19 receiving anakinra.