Association between high-dose steroid therapy, respiratory function, and time to discharge in patients with COVID-19: Cohort study

Rodríguez‐Molinero, Alejandro; Pérez-López, Carlos; Gálvez‐Barrón, César; Miñarro, Antonio; Gullello, Ezequiel A. Rodríguez; Pérez, Isabel; Ràfols, Núria Milà; Mónaco, Ernesto E.; García, Antonio Hidalgo; Carrasco, Gemma Añaños; Pastilla, Antonio Chamero

doi:10.1016/j.medcle.2020.08.001

Cited by 10 publications

(13 citation statements)

References 23 publications

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“…Several potential therapeutics have been proposed in the early phase of the COVID-19 pandemic, such as chloroquine, hydroxychloroquine, lopinavir/ritonavir, azithromycin, intravenous immune globulin, and convalescent plasma transfusion; but corticosteroids and remdesivir have been known to improve clinical outcome so far [ 10 , 11 ].. Corticosteroid, especially methylprednisolone, have been widely used in patients with severe COVID-19 cases in South Korea before the WHO and CDC made recommendations against using corticosteroid. Although some studies have shown that the usefulness of corticosteroid is limited [ 12 – 14 ], it has still become a potentially good therapeutic option as other studies, including the RECOVERY trial [ 11 ], have demonstrated beneficial effects of corticosteroid use [ 15 – 18 ]. The RECOVERY trial is a large-scale, prospective, well-designed study, which demonstrated that the use of dexamethasone reduces mortality in patients with severe COVID-19 [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of early corticosteroid use in patients with severe coronavirus disease 2019

et al. 2021

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Background Coronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents for this disease. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes. Methods This was a retrospective cohort study including patients with severe COVID-19 who received corticosteroid treatment from March 2 to June 30, 2020 in seven tertiary hospitals in South Korea. We analyzed the patient demographics, characteristics, and clinical outcomes according to the timing of steroid use. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids. Results Of the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10 days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO2/FiO2 ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08 days and the treatment duration was 14 days in the early use group, while those in the late use group were 12.80 days and 18.50 days, respectively. The PaO2/FiO2 ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4 days vs. 60.0 days, P = 0.030), time from diagnosis to discharge (27.8 days vs. 57.4 days, P = 0.024), and hospital stay (26.0 days vs. 53.9 days, P = 0.033) were shortened. Conclusions Among patients with severe COVID-19, early use of corticosteroids showed favorable clinical outcomes which were related to a reduction in the length of hospital stay.

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Section: Introductionmentioning

confidence: 99%

Effects of early corticosteroid use in patients with severe coronavirus disease 2019

et al. 2021

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“…5,21 In propensity-matched observational studies, there are reports of improved survival 22 but not by others. 23,24 We found significantly higher odds of death with higher dose steroids. With mortality averaging 32.6% in our study, this results in one excess death for every six patients receiving high-dose steroids.…”

Section: Corticosteroids In Ards Have Been Subjected To Severalmentioning

confidence: 59%

Do high‐dose corticosteroids improve outcomes in hospitalized COVID‐19 patients?

Kumar

Patel

Hererra

et al. 2021

Journal of Medical Virology

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Coronavirus disease 2019 (COVID-19) is characterized by dysregulated hyperimmune response and steroids have been shown to decrease mortality. However, whether higher dosing of steroids results in better outcomes has been debated. This was a retrospective observation of COVID-19 admissions between March 1, 2020, and March 10, 2021. Adult patients (≥18 years) who received more than 10 mg daily methylprednisolone equivalent dosing (MED) within the first 14 days were included.We excluded patients who were discharged or died within 7 days of admission. We compared the standard dose of steroids (<40 mg MED) versus the high dose of steroids (>40 mg MED). Inverse probability weighted regression adjustment (IPWRA) was used to examine whether higher dose steroids resulted in improved outcomes.The outcomes studied were in-hospital mortality, rate of acute kidney injury (AKI) requiring hemodialysis, invasive mechanical ventilation (IMV), hospital-associated infections (HAI), and readmissions. Of the 1379 patients meeting study criteria, 506 received less than 40 mg of MED (median dose 30 mg MED) and 873 received more than or equal to 40 mg of MED (median dose 78 mg MED). Unadjusted in-hospital mortality was higher in patients who received high-dose corticosteroids (40.7% vs. 18.6%, p < 0.001). On IPWRA, the use of high-dose corticosteroids was associated with higher odds of death (odds ratio [OR] 2.14; 95% confidence interval [CI] 1.45-3.14, p < 0.001) but not with the development of HAI, readmissions, or requirement of IMV. High-dose corticosteroids were associated with lower rates of AKI requiring hemodialysis (OR 0.33; 95% CI 0.18-0.63). In COVID-19, corticosteroids more than or equal to 40 mg MED were associated with higher in-hospital mortality.

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“…However, its use is still controversial and more research is needed. [18][19][20] Other studies have also found that the risk of syndrome severity and mortality is significantly high in patients with DM. In addition, individuals with impaired glucose tolerance or DM have been reported to have a 50-60% increased risk of lung infection.…”

Section: Discussionmentioning

confidence: 98%

“…The Coronavirus disease 2019 (COVID- 19), caused by SARS-CoV-2, was recognized as a new health issue in December 2019. Since then, it has been spread around the world and WHO declared COVID-19 a pandemic in March 2020.…”

Section: Introductionmentioning

confidence: 99%

Palliative Care and COVID-19 Pandemic: Retrospective Study of Factors Associated With Infection and Death at an Oncological Palliative Care Reference Center

Oliveira

Rosa

Durante

et al. 2021

Am J Hosp Palliat Care

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Background: Advanced cancer patients are part of a group likely to be more susceptible to COVID-19. Aims: To describe the profile of advanced cancer inpatients to an exclusive Palliative Care Unit (PCU) with the diagnosis of COVID-19, and to evaluate the factors associated with death in these cases. Design: Retrospective cohort study with data from advanced cancer inpatients to an exclusive PCU, from March to July 2020, with severe acute respiratory syndrome. Diagnostic of COVID-19 and death were the dependent variables. Logistic regression analyses were performed, with the odds ratio (OR) and 95% confidence interval (CI). Results: One hundred fifty-five patients were selected. The mean age was 60.9 (±13.4) years old and the most prevalent tumor type was breast (30.3%). Eighty-three (53.5%) patients had a diagnostic confirmation of COVID-19. Having diabetes mellitus (OR: 2.2; 95% CI: 1.1-6.6) and having received chemotherapy in less than 30 days before admission (OR: 3.8; 95% CI: 1.2-12.2) were associated factors to diagnosis of COVID-19. Among those infected, 81.9% died and, patients with Karnofsky Performance Status (KPS) < 30% (OR: 14.8; 95% CI 2.7-21.6) and C-reactive protein (CRP) >21.6mg/L (OR: 9.3; 95% CI 1.1-27.8), had a greater chance of achieving this outcome. Conclusion: Advanced cancer patients who underwent chemotherapy in less than 30 days before admission and who had diabetes mellitus were more likely to develop Coronavirus 2019 disease. Among the confirmed cases, those hospitalized with worse KPS and bigger CRP were more likely to die.

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Association between high-dose steroid therapy, respiratory function, and time to discharge in patients with COVID-19: Cohort study

Cited by 10 publications

References 23 publications

Effects of early corticosteroid use in patients with severe coronavirus disease 2019

Effects of early corticosteroid use in patients with severe coronavirus disease 2019

Do high‐dose corticosteroids improve outcomes in hospitalized COVID‐19 patients?

Palliative Care and COVID-19 Pandemic: Retrospective Study of Factors Associated With Infection and Death at an Oncological Palliative Care Reference Center

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