Definitions and Diagnosis
Axillary temperature over 37.3°C was regarded as fever. Presence of
signs and symptoms of bacteremia or pneumonia together with an
endotracheal aspirate or lower respiratory tract sputum culture positive
for a new pathogen was evaluated as secondary bacterial infection.
Patients diagnosed as having ventilator-associated or hospital-acquired
pneumonia were treated according to the available guidelines. ARDS was
diagnosed and classified using the 2015 Berlin diagnostic criteria. If
the daily cardiac-specific troponin-I level of the patients was above
normal, the patient was evaluated by echocardiography for newly
developed cardiac pathologies. Coagulopathy was defined as prothrombin
and partial thromboplastin times prolonged by 3 s and 5 s, respectively.
Based on disease severity, treatment was planned according to the
COVID-19 adult diagnosis and treatment guidelines published by the
Turkish Ministry of Health. Patients exhibiting findings such as
persistent fever, C-reactive protein (CRP), and ferritin levels that
remain high or continue to increase, D-dimer elevation, thrombocytopenia
or lymphopenia, abnormal liver function tests, hypofibrinogenemia, or
elevated triglyceride levels despite treatment were followed up for MAS.
If repeated measures of these parameters showed continued deterioration
that could not be explained by secondary bacterial infection, the
patients were given 400 mg tocilizumab for MAS if not contraindicated.
Clinical and laboratory response was evaluated after 24 hours. Only
patients who did not respond were given another 400 mg of tocilizumab.