الفهرس 
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Abstract
Our study was performed on 82 patients with Covid 19 infection admitted to cardiothoracic Minia university hospital , chest department, isolation sector, during the period from February 2021 to February 2022.
Patients in this study were classified into two groups: group I included 65 cases, who were treated with tocilizumab as a main line of treatment among Covid 19 protocol, and group II included 17 cases ,who didn’t receive tocilizumab.
All patients had been subjected to the following :
• History taking (either from the patients or their relatives ) including :age, sex , occupation , smoking status , history of chronic illness , comorbidities
• Initial clinical assessment (including vital signs , general examination and local chest examination) then daily follow up for signs of improvement or deterioration.
• Follow up oxygen saturation and ABG.
• Routine laboratory investigation as needed which include important indicators for following up ,like (CBC , LDH ,S.ferritin ,CRP ,D.dimer )
• RT-PCR, which is a mandatory for diagnosis of Covid 19.
• Chest imaging : HRCT chest which is an important indicator for the suspicious of covid 19
After collection and analysis of the data , we were able to compare between the two groups and concluded the predictors of improvemet at the level of : duration of hospitalization , oxygen status , laboratory changes, clinical
outcome and mortality…so we found that :
• The group I (who received tocilizumab) had higher BMI than group II who didn’t receive tocilizumab ( p=0.006*) . Also there was a significant difference between the two groups in onset of appearance of symptoms before hospitalization ( p= 0.0001* ), so we found that the earlier we gave tocilizumab , the more benefit obtained .
• We also found that there was noticable improvement regarding oxygen status in group I (tocilizumab group) at the level of SpO2 (p= 0.0001*) , P/F ratio (p= <0.0001*) which were greatly improved 1 week after giving tocilizumab compared to group II (control group).
• More over ,we found that there was a significant reduction in inflammatory markers (Serum ferritin ,CRP,LDH) in group I after 1 week of tocilizumab (p=0.0001*) . compared to group II in which we noticed only CRP had valuable and significant reduction,(p= 0.028*).
• We noticed that the duration of NIV use was shorter in group I who received tocilizumab, (p= 0.022*).
• Also we found that the duration of use corticosteroids was shorter in group I who received corticosteroids combined with tocilizumab, (p=0.013*).
• We found that many successful indicators were achieved in group I who received tocilizumab including shorter hospital stay (p=0.013*) , lower mortality rate (p=0.02*) , good clinical outcome ( high percentage of patients discharged alive either on room air or need home oxygen for a period of time ) P=0.49* , of course this is compared to group II ( control group ) .
Conclusion
Our study revealed that :
• Use of tocilizumab is most effective in patients with Covid 19 who have high levels of inflammatory activity, who are at an early stage of lung involvement and who do not respond to high-dose corticosteroid therapy, who have no bacterial superinfection .
• Timing of giving tocilizumab is very important to achieve maximum benefits and rule out its harm effects .
• Good selection of the patients who can be treated with tocilizumab is important ( however their need , but many patients are’nt suitable for receiving tocilizumab like : pregnant women, children and infants , patients with active tuberculosis, bacterial infection, ….)
• Tocilizumab had many predictors of success among covid 19 patients at the level of ( oxygen status , clinical outcome , mortality rate , duration of hospitalization , inflammatory markers and duration of mechanical ventilation ).