CASE SERIES
The novel coronavirus SARS-CoV-2 was identified in four critically ill patients who developed ARDS. Treatment target was the cytokine storm created by SARS-CoV-2 infection. After receiving leronlimab, all four patients initially survived. Two patients went on to recover and
were discharged from hospital, while the other two patients subsequently died of surgical complications after making an initial recovery from SARS-CoV-2 infection. All four patients clinically improved as measured by vasopressor support, and discontinuation of hemodialysis
and mechanical ventilation. None of the patients developed a thromboembolic event after leronlimab injection. Demographics including age, date of hospital admission, date of intubation, days intubated before administration of leronlimab, significant past medical history, duration of symptoms before hospital admission, and the use of investigational drugs administered before leronlimab are listed in Table 2. The average age of these four patients was 60 years. Three females were hospitalized in early April and one male was hospitalized at the end of May. The mean time to intubation from date of hospitalization was 2 days. The number of days the patients were intubated prior to receiving leronlimab ranged from 4–15 days, with a mean of 7 days. The most common comorbidity was being a former or current smoker. Two of the four patients had a history of chronic obstructive pulmonary disease (COPD). Patients A and D had a concurrent diagnosis of right upper extremity deep vein thrombosis (DVT) before administration of leronlimab; none of the patients developed a thromboembolic event after leronlimab injection. Patients B, C, and D developed acute kidney injury requiring hemodialysis, while patient A did not. The mean duration of symptoms before hospitalization was 7 days (range 2–10 days). Investigational drugs the patients received during their hospital course included hydroxychloroquine, zinc, tocilizumab, remdesivir, and azithromycin. Total days in the intensive care unit (ICU) and total days in the ICU after treatment with leronlimab could only be calculated for patients A and B, which were 21 and 10 days, and 18 and 4 days, respectively.
Patient C developed an unstageable ulcer and died due to complications after a diverting ostomy in an effort to prevent wound infection. Before his death patient C was on daily hemodialysis once per week with improved creatinine clearance. Before the deaths of patients C and D, neither required vasopressors; patient C had a tracheostomy and was on the ventilator twelve hours per day, while patient D had been extubated for 24 hours and was re-intubated due to tachypnea. Patient D clinically improved and at the time of death was on weaning parameters for extubation. Patient D died due to iatrogenic perforation of the colon during the placement of a gastrostomy tube. Patient A and patient B were respectively removed from oxygen on Day 19 and Day 17 and discharged from the hospital 38 and 50 days after admission.
The novel coronavirus SARS-CoV-2 was identified in four critically ill patients who developed ARDS. Treatment target was the cytokine storm created by SARS-CoV-2 infection. After receiving leronlimab, all four patients initially survived. Two patients went on to recover and
were discharged from hospital, while the other two patients subsequently died of surgical complications after making an initial recovery from SARS-CoV-2 infection. All four patients clinically improved as measured by vasopressor support, and discontinuation of hemodialysis
and mechanical ventilation. None of the patients developed a thromboembolic event after leronlimab injection. Demographics including age, date of hospital admission, date of intubation, days intubated before administration of leronlimab, significant past medical history, duration of symptoms before hospital admission, and the use of investigational drugs administered before leronlimab are listed in Table 2. The average age of these four patients was 60 years. Three females were hospitalized in early April and one male was hospitalized at the end of May. The mean time to intubation from date of hospitalization was 2 days. The number of days the patients were intubated prior to receiving leronlimab ranged from 4–15 days, with a mean of 7 days. The most common comorbidity was being a former or current smoker. Two of the four patients had a history of chronic obstructive pulmonary disease (COPD). Patients A and D had a concurrent diagnosis of right upper extremity deep vein thrombosis (DVT) before administration of leronlimab; none of the patients developed a thromboembolic event after leronlimab injection. Patients B, C, and D developed acute kidney injury requiring hemodialysis, while patient A did not. The mean duration of symptoms before hospitalization was 7 days (range 2–10 days). Investigational drugs the patients received during their hospital course included hydroxychloroquine, zinc, tocilizumab, remdesivir, and azithromycin. Total days in the intensive care unit (ICU) and total days in the ICU after treatment with leronlimab could only be calculated for patients A and B, which were 21 and 10 days, and 18 and 4 days, respectively.
Patient C developed an unstageable ulcer and died due to complications after a diverting ostomy in an effort to prevent wound infection. Before his death patient C was on daily hemodialysis once per week with improved creatinine clearance. Before the deaths of patients C and D, neither required vasopressors; patient C had a tracheostomy and was on the ventilator twelve hours per day, while patient D had been extubated for 24 hours and was re-intubated due to tachypnea. Patient D clinically improved and at the time of death was on weaning parameters for extubation. Patient D died due to iatrogenic perforation of the colon during the placement of a gastrostomy tube. Patient A and patient B were respectively removed from oxygen on Day 19 and Day 17 and discharged from the hospital 38 and 50 days after admission.
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