Can the Early Warning Score (ANDC) Predict Tocilizumab Efficacy in Patients with COVID-19 Cytokine Storm?

Abstract

Background: The aim of this study is to assess the effectiveness of the Early Warning Score [ANDC (age (A), neutrophil-to-lymphocyte ratio (NLR (N)), D-dimer (D), and CRP (C)] in predicting the treatment response in patients receiving tocilizumab for Coronavirus Disease 2019 (COVID-19)-related cytokine storm.

Methods: A retrospective review of medical records was conducted for patients treated with tocilizumab for a cytokine storm related to COVID-19 between April 1, 2020, and April 1, 2021. Patient demographics, clinical characteristics, and laboratory parameters within 24 hours before tocilizumab were recorded. 1.14 × (age − 20) (years)+1.63 × NLR+5.00 × D-dimer (mg/L)+0.14 × C-reactive protein (CRP) (mg/L) was used as the formula for the ANDC score. The study population was divided into 2 groups: those who died within 28 days of receiving tocilizumab and those who recovered. A comparative analysis was conducted.

Results: Within 28 days of tocilizumab treatment, 59 (35.32%) patients died. In comparison with living patients, deceased patients exhibited considerably higher levels of interleukin (IL)-6, lactate dehydrogenase (LDH), ANDC score, and CRP (P < .05). Lactate dehydrogenase was an independent predictor of response to tocilizumab treatment (P < .001) in a multivariate logistic regression analysis. In patients who did not receive steroid therapy before tocilizumab treatment, the ANDC score had the highest area under the curve (AUC). The optimal cut-off value was determined to be 92.56, with a sensitivity of 91.67% and a specificity of 60.61% (P < .001). In patients receiving steroids before tocilizumab, LDH had the highest AUC. The optimal cut-off value was 484.5 U/L (P < .001).

Conclusion: Lactate dehydrogenase was identified as an independent predictor of response to tocilizumab treatment. The ANDC score showed the highest AUC value in steroid-naïve patients before tocilizumab, whereas LDH showed the highest AUC value in patients receiving steroids before tocilizumab. Both the ANDC score and LDH levels show potential as valuable tools to guide treatment decisions.

Cite this article as: Kılıç Ö, Tecer D, Nur Kaya M, Çınar M, Yılmaz S. Can the
early warning score (ANDC) predict tocilizumab efficacy in patients with
COVID-19 cytokine storm?. Eur J Rheumatol. 2025, 12(1), 0048, doi:
10.5152/eurjrheum.2025.24048.