{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:58:38Z","timestamp":1789664318372,"version":"4.0.1"},"reference-count":26,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,16]],"date-time":"2025-03-16T00:00:00Z","timestamp":1742083200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chang Gung Memorial Hospital","award":["CORPG3M0341"],"award-info":[{"award-number":["CORPG3M0341"]}]},{"name":"Chang Gung Memorial Hospital","award":["CORPG3M0351"],"award-info":[{"award-number":["CORPG3M0351"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cells"],"abstract":"<jats:p>Background: Pediatric sepsis remains the main cause of morbidity and mortality among children. Interleukin (IL)-6 is usually produced after infection, and elevated IL-6 levels may cause multisystemic damage. This study aimed to evaluate the effect of tocilizumab, an IL-6 receptor antibody, on children with septic shock. Methods: We conducted a retrospective cohort study of children diagnosed with septic shock and admitted to the pediatric intensive care unit (PICU) between 2018 and 2024. Tocilizumab was administered within 24 h to patients with high IL-6 levels who developed refractory septic shock. Outcomes, including 28-day mortality, morbidity, length of PICU stay, and shock duration, were analyzed between septic children with different etiologies and differed treatments. Results: Fifty-four children with refractory septic shock were included. Patients treated with tocilizumab (n = 21) showed improved outcomes compared to those without tocilizumab (n = 33), including shorter PICU stays and lower mortality rates (14.2% vs. 54.5%, p = 0.03). Subgroup analysis revealed that in the non-hematologic group, tocilizumab-treated patients had a 0% mortality rate compared to 50% in untreated patients (p = 0.006). In the hematologic group, tocilizumab-treated patients exhibited a 27.2% mortality rate compared to 61.5% in untreated patients (p = 0.09). Trends in IL-6 levels (D1 to D7) were significantly higher in non-survivors compared to survivors and in patients with hematological malignancies compared to those without. No adverse events, including secondary infections or long-term liver impairment, were observed. Conclusions: Tocilizumab appears to mitigate systemic inflammation and improve outcomes in children with refractory septic shock and elevated IL-6 levels. Further prospective studies are warranted to confirm these findings and establish treatment guidelines.<\/jats:p>","DOI":"10.3390\/cells14060441","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T08:57:02Z","timestamp":1742201822000},"page":"441","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Clinical Value of Tocilizumab in Reducing Mortality in Refractory Septic Shock in Children with Hematologic and Non-Hematologic Diseases"],"prefix":"10.3390","volume":"14","author":[{"given":"En-Pei","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan 33305, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5592-6343","authenticated-orcid":false,"given":"Jainn-Jim","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan 33305, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2588-2735","authenticated-orcid":false,"given":"Shih-Hsiang","family":"Chen","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan"},{"name":"Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33315, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oi-Wa","family":"Chan","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan 33305, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya-Ting","family":"Su","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan"},{"name":"Division of Pediatric Endocrinology and Genetics, Department of Pediatrics, Chang Gung Memorial Hospital, Taipei 10507, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Man-Ru","family":"Hsiao","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan"},{"name":"Department of Pharmacy, Chang Gung Memorial Hospital, Taoyuan 33315, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao-Hsuan","family":"Hsia","sequence":"additional","affiliation":[{"name":"Physician Assistant Department, University of Maryland Eastern Shore, Princess Anne, MD 21853, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0069-4183","authenticated-orcid":false,"given":"Han-Ping","family":"Wu","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan"},{"name":"Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1164\/rccm.201412-2323OC","article-title":"Global epidemiology of pediatric severe sepsis: The sepsis prevalence, outcomes, and therapies study","volume":"191","author":"Weiss","year":"2015","journal-title":"Am. 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