Publication date: Jul 06, 2025

Respiratory pandemics like COVID-19 continued to strain healthcare systems worldwide. Numerous antiviral, antimalarial, and anti-inflammatory treatments were administered to many patients to pursue effective therapeutics. This study aims to assess the efficacy of the anti-inflammatory agent tocilizumab for critically ill patients, specifically in managing respiratory illnesses. This multi-center cohort study included laboratory-confirmed SARS-CoV-2 patients as special cases admitted to the intensive care units (ICUs) of 15 hospitals across Saudi Arabia between March 1, 2020, and October 30, 2020. A total of 1470 critically ill patients with SARS-CoV-2 were included. The study included 1470 patients with a mean age of 55. 9 +/- 15. 1 years; 1088 (74. 0%) were male and 382 (26. 0%) female. Among them, 29% received Tocilizumab, while 71% received other treatments such as remdesivir, hydroxychloroquine, corticosteroids, convalescent plasma, intravenous immunoglobulin, and plasmapheresis. The median Sequential Organ Failure Assessment (SOFA) score for the cohort was 5 [IQR 3-8], with lower scores observed in the Tocilizumab administered group (p = 0. 143). ICU mortality was significantly lower in the tocilizumab group: 150/426 (35. 2%) versus 457/1044 (43. 8%), p = 0. 004. The median length of ICU stay was longer in the Tocilizumab group (12 days; IQR 7-21) than in the non-Tocilizumab group (8 days; IQR 4-15). However, Tocilizumab use was associated with a reduced likelihood of prolonged ICU stay (adjusted OR 0. 68; 95% CI 0. 57-0. 83; p 

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