Steroid exposure and outcome in COVID-19 pneumonia

Remmington, Christopher; Barrett, Nicholas A; Agarwal, Sangita; Lams, Boris; Collins, Patrick; Camarda, V; Meadows, Chris; Hanks, Fraser; Sanderson, Barnaby; Retter, Andrew; Camporota, Luigi

doi:10.1016/j.bjao.2023.100128

Cited by 3 publications

(2 citation statements)

References 27 publications

(52 reference statements)

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“…While the RECOVERY trial did find a positive effect of steroids on mortality for patients on mechanical ventilation for COVID-related respiratory distress [ 10 ], this effect was not observed when patients were monitored for 90 days [ 11 , 12 ]. Consequently, the short-term and long-term benefits of steroids in COVID-19 are an area of ongoing research [ 13 ]. Hence, it is plausible that the lack of treatment with steroids may have contributed to the development of autoimmune encephalitis and consequent cognitive deficits [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Cognitive Deficits and Behavioral Symptoms Following COVID-19-Associated Autoimmune Encephalitis With Intravenous Immunoglobulin: A Case Report and Review of the Literature

Naeem,

Oros,

Adams

et al. 2023

Cureus

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Coronavirus disease 2019 (COVID-19) is associated with long-term neuropsychiatric sequelae. We describe a 60-year-old male patient's history and symptom trajectory encompassing the development of behavioral symptoms and cognitive deficits following pneumonia and subsequent autoimmune encephalitis associated with COVID-19. We also describe changes in these facets with correlative changes in his immunological parameters after both acute intravenous immunoglobulin (IVIG) therapy and chronic periodic IVIG therapy every two weeks over the course of two years. We review the literature on the treatment of long COVID-19 symptoms spanning cognitive and behavioral domains. In addition, we also elucidate current literature on the role of IVIG infusions for these symptoms using our patient's presentation and improvement in symptoms as an illustrative example.

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Section: Discussionmentioning

confidence: 99%

Treatment of Cognitive Deficits and Behavioral Symptoms Following COVID-19-Associated Autoimmune Encephalitis With Intravenous Immunoglobulin: A Case Report and Review of the Literature

Naeem,

Oros,

Adams

et al. 2023

Cureus

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“…It downregulates the hyperactivation of the components of both innate (neutrophils) and acquired (T and B lymphocytes) immune system and the cytokine storm that characterizes severe cases of COVID-19 [9]. It was widely used in patients with COVID-19 pneumonia, while its e cacy and optimal dose remain controversial [10][11][12]. And several observational studies suggested that corticosteroid treatment may increase mortality to some extent [13,14].…”

Section: Introductionmentioning

confidence: 99%

Corticosteroids for hospitalized patients with severe/critical COVID-19: a retrospective study in Chongqing, China

Zhuang

Xia²,

et al. 2023

Preprint

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Background To estimate the association between the administration of corticosteroids and all-cause mortality of hospitalized patients with severe/critical Corona Virus Disease 2019 (COVID-19). Methods We conducted this study at six tertiary hospitals in the area of Chongqing, China. Clinical records from all consecutive adult subjects admitted with SARS-CoV-2 infection from 1 November 2022 to 20 January 2023 were retrospectively reviewed. In-hospital and 28-day mortality were analyzed before and after propensity score matching (PSM). Logistic regression model and cox regression model was used to further examine the relationship between corticosteroid treatment and the risk of mortality. Results A total of 406 severe and critically ill COVID-19 patients were included in this study. They were divided into the corticosteroids group (231, 56.9%) and non-corticosteroids group (175, 43.1%) according to corticosteroids use (0.5-1mg/kg/d methylprednisolone or any corticosteroid at equivalent dose, no more than 10 days). Corticosteroid treatment did not reduce in-hospital mortality in overall cohorts (36.4% vs.28.0%) and matched cohorts (32.5% vs.34.5%). Univariate analysis showed that the 28-day mortality in the corticosteroids group was significantly higher than that in the non-corticosteroids group [hazard ratio (HR), 0.706; 95% CI, 0.507–0.983; p = 0.039] in the overall population. When the multivariate analysis was further used to control confounders, the results showed that corticosteroids were not associated with improved 28-day mortality (HR, 1.121; 95% CI, 0.641–1.959; p = 0.689). With PSM, similar results were obtained with univariate and multivariate analysis. Conclusions Corticosteroids in hospitalized patients with severe/critical COVID-19 did not reduce mortality in the overall population.

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Corticosteroids for hospitalized patients with severe/critical COVID-19: a retrospective study in Chongqing, China

Zhuang,

Xia,

et al. 2024

Sci Rep

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Corticosteroids have always been recommended for severe cases of COVID-19. However, the efficacy of treatment with corticosteroids for COVID-19 during the SARS-CoV-2 omicron outbreak in China has not been reported. Clinical data from 406 patients hospitalized for severe/critical COVID-19 from December 2022 to January 2023 at six hospitals in Chongqing were retrospectively analyzed. The primary outcome was all-cause mortality at 28 days in the groups with and without corticosteroids treatment after propensity score matching (PSM). Secondary outcomes were to compare in-hospital mortality and length of survival time with corticosteroids and those without corticosteroids. This study included 406 patients with severe or critical COVID-19, divided into the corticosteroids group (231, 56.9%) and non-corticosteroids group (175, 43.1%). After PSM, the use of corticosteroids did not reduce all-cause mortality at 28 days (42.5% vs. 39.1%). Univariate analysis showed that corticosteroids were not associated with improved all-cause mortality at 28 days [hazard ratio (HR), 1.019; 95% confidence interval (CI), 0.639–1.623; p = 0.938]. Multivariate analysis showed similar results (HR, 1.047; 95% CI, 0.633–1.732; p = 0.858). Among non-survivors, the survival time was significantly larger in those who received corticosteroids compared with the non-corticosteroid users [median 13 (IQR 6.5–15.5) vs. 6 (4-11.25), p = 0.007]. The use of systemic corticosteroids in severe/critical COVID-19 may provide certain potential survival benefits but does not improve prognosis. Supplementary Information The online version contains supplementary material available at 10.1038/s41598-024-75926-9.

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Steroid exposure and outcome in COVID-19 pneumonia

Cited by 3 publications

References 27 publications

Treatment of Cognitive Deficits and Behavioral Symptoms Following COVID-19-Associated Autoimmune Encephalitis With Intravenous Immunoglobulin: A Case Report and Review of the Literature

Treatment of Cognitive Deficits and Behavioral Symptoms Following COVID-19-Associated Autoimmune Encephalitis With Intravenous Immunoglobulin: A Case Report and Review of the Literature

Corticosteroids for hospitalized patients with severe/critical COVID-19: a retrospective study in Chongqing, China

Corticosteroids for hospitalized patients with severe/critical COVID-19: a retrospective study in Chongqing, China

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