Background: The leading cause in COVID-19 patients is development of cytokine storm .    Material and Methods: This study was conducted in a tertiary center with diagnosis of COVID-19 patients. Clinical and laboratory features of patients were obtained from their medical cards and hospital software system and evaluated by retrospectively.                    Statistical analysis: In our study, 21.0 version (IBM, Armonk, NY, USA) of the SPSS (Statistical Package for the Social Sciences) program was used for statistical analysis of data. Descriptive statistics, discrete and continuous numerical variables were expressed as mean, ± standard deviation or median and interquartile range (IQR). Categorical variables were expressed as number of cases and (%). Cross table statistics were used to compare categorical variables (Chi-Square, Fisher exact test). Normally distributed parametric data were compared with Student’s t-test and Paired t-test; non-parametric data that did not meet normal distribution were compared with Mann Whitney U and Kruskal Wallis tests. Multiple intergroup comparisons were made by Post Hoc Tukey analysis. Kaplan-Meier and log-rank methods were used for survival analysis. Multivariable analysis was performed by using logistic regression. Correlation analysis was performed with Pearson or Spearman method according to normality distribution.  p<0.05 value was considered statistically significant.   Results: Data of 15 patients in combination group and 43 patients in control group were evaluated and included into the study. Of these patients 73.3% was male in combination arm and 72.1% in control group (p=0.9). Demographic findings and frequency of comorbidities were similar between two groups (table 1). Overall mortality was 46.7% (n=7) in combination arm and 69.8% (n=30) in control group although it was not statistically significant (p=0.1). Similarly, need of intubation was also lower in combination arm (46.7%) compared to control group (69.8%), it was not significantly different (p=0.1). ICU admission was significantly lower in combination (46.7%, n=7) arm than control group (76.7%, n=33) (p=0.03, Odds ratio [OR]:4.7). Development of severe infection (20%, n=3 vs 25%, n=9/36), pulmonary embolism (6.7%, n=1 vs 0), myocardial infarction (6.7%, n=1 vs 2.6%, n=1/38) and pneumothorax (13.3%, n=2 vs 2.6%, n=1/38) were not different between two groups (p=0.7, p=0.3, p=0.5 and p=0.2). In multivariable analysis only cHIS score was associated with high mortality (p=0.018, OR:2.8, [95% confidence interval: 1.2-6.6]). In survival analysis, mortality rate was significantly lower in combination arm than control group (Log-Rank:p=0.04;figure 1). In conclusion, combination therapy of high-dose anakinra and baricitinib may be an adequate treatment option in patients with COVID-19 who had critical disease and no additional safety signal.

Introduction: In our study, we aimed to evaluate the effect of high dose intravenous anakinra treatment on development of thrombotic events in severe and critical COVID-19 patients. Material and methods: This retrospective observational study was conducted at a tertiary referral center in Aksaray, Turkey. The study population consisted of two groups as follows; the patients receiving high dose intravenous anakinra (anakinra group) added to background therapy and the patients treated with standard of care (SoC) as historical control group. Age, gender, mcHIS scores, and comorbidities such as DM, HT, and CHD of the patients were determined as the variables to be matched. Results: We included 114 patients in SoC and 139 patients in Anakinra group into the study. Development of any thromboembolic event (5% vs 12.3%, p=0.038; OR:4.3) and PTE (2.9% vs 9.6%, p=0.023; OR:5.1) were lower in Anakinra group than SoC. No patient experienced CVA and/or clinically evident DVT both in two arms. After 1:1 PS matching, 88 patients in SoC and 88 patients in Anakinra group were matched and included into the analysis. In survival analysis, development of any thromboembolic event, PTE, and MI were higher in SoC compared to Anakinra. Survival rate was also lower in patients with SoC arm than Anakinra in patients who had any thromboembolic event as well as MI. Conclusion: In our study, development of thrombosis were associated with hyperinflammation in patients with severe and critical COVID-19. Intravenous high-dose anakinra treatment decreases both venous and arterial events in patients with COVID-19.