{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T18:15:20Z","timestamp":1788372920725,"version":"build-2803163510"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Interleukin-1 and interleukin-6 blockade have been widely used in severe COVID-19, but comparative real-world evidence regarding anakinra and tocilizumab in critically ill patients remains limited. We evaluated the associations of first initiation of anakinra or tocilizumab with 28-day and overall in-hospital mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective ICU cohort included adults with severe COVID-19. During hospital days 2\u201310, daily actions were classified as anakinra initiation, tocilizumab initiation, or control\/defer. Calibrated overlap-weighted modified-Poisson models estimated associations with 28-day and overall in-hospital mortality; ferritin-adjusted sensitivity analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 306 patients, 241 patients contributed 1,297 eligible person-days. Calibration met the prespecified balance criterion for the included covariates, although effective support for tocilizumab initiation remained limited. For 28-day in-hospital mortality, adjusted RRs versus control\/defer were 0.99 (95% CI, 0.80\u20131.22) for anakinra and 0.99 (95% CI, 0.71\u20131.37) for tocilizumab. No clear associations were identified in the head-to-head comparison or for overall in-hospital mortality; ferritin-adjusted estimates were similar.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this retrospective ICU cohort, neither anakinra nor tocilizumab initiation showed a clear association with 28-day or overall in-hospital mortality. Estimates were imprecise, particularly for tocilizumab, and remain susceptible to residual confounding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0357671","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T17:34:15Z","timestamp":1788370455000},"page":"e0357671","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative associations of Anakinra and Tocilizumab initiation with in-hospital mortality in severe COVID-19: A single-center sequential cohort study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5131-6983","authenticated-orcid":true,"given":"Fevzi Necati","family":"Avsar","sequence":"first","affiliation":[{"name":"Sanliurfa Mehmet Akif Inan Training and Research Hospital, University of Health Sciences","place":["T\u00fcrkiye"],"department":["Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nihat","family":"K\u0131l\u0131caslan","sequence":"additional","affiliation":[{"name":"Sanliurfa Mehmet Akif Inan Training and Research Hospital, University of Health Sciences","place":["T\u00fcrkiye"],"department":["Department of Radiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2015-4421","authenticated-orcid":true,"given":"Tuncay","family":"Sahutoglu","sequence":"additional","affiliation":[{"name":"Sanliurfa Mehmet Akif Inan Training and Research Hospital, University of Health Sciences","place":["T\u00fcrkiye"],"department":["Division of Nephrology, Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"issue":"18","key":"pone.0357671.ref001","doi-asserted-by":"crossref","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical characteristics 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