A Retrospective Cohort Study Comparing the Clinical Outcomes of Patients with Severe COVID-19 Treated with Different Regimens

Aims: This study evaluated the clinical effects of five treatment regimens, including tocilizumab plus baricitinib, tocilizumab plus co-trimoxazole, tocilizumab alone, high-dose corticosteroids, and high-dose corticosteroids plus baricitinib, on treatment outcomes of patients with severe COVID-19.
Materials & Methods: In this retrospective cohort study, 50 patients with severe COVID-19, who were admitted to the intensive care unit of Shafa hospital in Khorramabad (western Iran) from April to December 2021, were divided into five treatment groups: tocilizumab plus baricitinib, tocilizumab plus co-trimoxazole, tocilizumab alone, high-dose corticosteroids alone, and high-dose corticosteroids plus baricitinib. Patients were assessed based on vital signs, radiological imaging, clinical symptoms, and laboratory parameters recorded at baseline and throughout hospitalization.
Findings: The group receiving tocilizumab plus co-trimoxazole alongside standard therapy achieved the highest recovery rate (100%), whereas the group receiving tocilizumab plus baricitinib had the highest mortality rate (90%). These differences were statistically significant (p< .05). Mortality was also significantly associated with anemia; thrombocytopenia; elevated levels of CRP, ferritin, and LDH; and extensive pulmonary involvement (p< .05).
Conclusion: The findings indicated that regimens involving tocilizumab plus co-trimoxazole, corticosteroids plus baricitinib, or tocilizumab monotherapy were associated with lower mortality rates and improved recovery outcomes in patients with severe COVID-19. In contrast, the concurrent administration of tocilizumab and baricitinib was associated with higher mortality rates, possibly due to excessive immunosuppression. Elevated levels of CRP, ferritin, LDH, AST, and ALT, along with extensive lung involvement and anemia, were identified as significant predictors of mortality. Larger cohort studies are needed to confirm these findings.