TOCILIZUMAB - An Option for Patients With COVID-19 Associated Cytokine Release Syndrome; A Single Center Experience

* Inclusion Criteria: * All patients diagnosed with COVID-19 infection with positive reverse transcriptase RT-PCR test, willing to participate in this study or PCR negative patients with clinically COVID-19 Pneumonia in cytokine storm as evidenced by raised inflammatory markers with typical radiological changes * Patients of both genders were included * Patients having an age of \> 65 years with proven Cardiomyopathy, Coronary artery disease, chronic lung disease, Immunosuppressed or organ transplant End-stage renal disease on history \& examination and medical records and having any 1 out of 4 Fever 0f * ≥39 C * Hypotension or drop in mean arterial pressure of \> 10mmHg * Progressive Hypoxemia requiring \> 5 liters of oxygen * Sustained Respiratory rate \>30/min with any 2 laboratory parameters out of 3 are present D-dimers ≥ 1000 ng/ml C-reactive protein CRP ≥ 100mg/L Ferritin ≥ 600ng/ml * Patients having low risk or no comorbidities and having an age of \<65 years with having any 3 out of 4 Fever 0f * ≥39 C * Hypotension or drop in mean arterial pressure of \> 10mmHg * Progressive Hypoxemia requiring \> 5 liters of oxygen * Sustained Respiratory rate \>30/min With any 2 laboratory parameters out of 3 are present D-dimers ≥ 1000 ng/ml C-reactive protein CRP ≥ 100mg/L Ferritin ≥ 600ng/ml * Moderate severe or severe COVID 19 features 1. Shortness of breath oxygen saturation \<93% on room air 2. Progressive Hypoxemia requiring \> 5 liters of oxygen 3. Respiratory rate \>30/min 4. The partial pressure of arterial oxygen to fraction of inspired oxygen ratio\<300 5. Lung infiltrates on Chest x-ray CXR \>50% within 24 to 48 hrs 6. Respiratory failure * Exclusion Criteria: * Known severe allergic reactions to Tocilizumab or any other monoclonal antibody * Pregnancy or breastfeeding * Absolute Neutrophil Count(ANC) \< 1000 * Alanine aminotransferase(ALT) or aspartate aminotransferase (AST) \> 5 times upper normal limit * Platelet count of \< 50,000 * Bowel diverticulitis or bowel perforation * Patients having Acute pancreatitis