Use of glucocorticoids megadoses in SARS-CoV-2 infection in a spanish registry: SEMI-COVID-19.

Autor: Lavilla Olleros C; General Internal Medicine Department, Hospital Universitario Gregorio Marañón, Madrid, Spain., Ausín García C; General Internal Medicine Department, Hospital Universitario Gregorio Marañón, Madrid, Spain., Bendala Estrada AD; General Internal Medicine Department, Hospital Universitario Gregorio Marañón, Madrid, Spain., Muñoz A; General Internal Medicine Department, Infanta Cristina Hospital: Hospital Universitario Infanta 2 Cristina, Parla-Madrid, Spain., Wikman Jogersen PE; General Internal Medicine Department, Hospital Universitario San Juan de Alicante, San Juan de Alicante-Alicante, Spain., Fernández Cruz A; General Internal Medicine Department, Hospital Universitario Puerta de Hierro, Madrid, Spain., Giner Galvañ V; General Internal Medicine Department, Hospital Universitario San Juan de Alicante, San Juan de Alicante-Alicante, Spain., Vargas JA; General Internal Medicine Department, Hospital Universitario Puerta de Hierro, Madrid, Spain., Seguí Ripoll JM; General Internal Medicine Department, Hospital Universitario San Juan de Alicante, San Juan de Alicante-Alicante, Spain., Rubio-Rivas M; General Internal Medicine Department, H. Univ. de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain., Miranda Godoy R; General Internal Medicine Department, 12th of October University Hospital: Hospital Universitario 12 de Octubre, Madrid, Spain., Mérida Rodrigo L; General Internal Medicine Department, Hospital Costa del Sol, Málaga, Spain., Fonseca Aizpuru E; General Internal Medicine Department, Hospital de Cabueñes: Hospital de Cabuenes, Gijón, Spain., Arnalich Fernández F; General Internal Medicine Department, La Paz University Hospital: Hospital Universitario La Paz, Madrid, Spain., Artero A; General Internal Medicine Department, Hospital Universitario Dr Peset: Hospital Universitario Doctor Peset, Valencia, Spain., Loureiro Amigo J; General Internal Medicine Department, Hospital de Sant Joan Despí Moisès Broggi: Hospital de Sant Joan Despi Moises Broggi, Barcelona, Spain., García García GM; General Internal Medicine Department, University Hospital Complex Badajoz: Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain., Corral Gudino L; Hospital Universitario Rio Ortega, Valladolid, Spain., Jiménez Torres J; General Internal Medicine Department, Hospital Reina Sofía: Hospital Reina Sofia, Córdoba, Madrid, Spain., Casas-Rojo JM; General Internal Medicine Department, Infanta Cristina Hospital: Hospital Universitario Infanta Cristina, Parla-Madrid, Spain., Millán Núñez-Cortés J; General Internal Medicine Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 Jan 21; Vol. 17 (1), pp. e0261711. Date of Electronic Publication: 2022 Jan 21 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0261711
Abstrakt: Objective: To describe the impact of different doses of corticosteroids on the evolution of patients with COVID-19 pneumonia, based on the potential benefit of the non-genomic mechanism of these drugs at higher doses.
Methods: Observational study using data collected from the SEMI-COVID-19 Registry. We evaluated the epidemiological, radiological and analytical scenario between patients treated with megadoses therapy of corticosteroids vs low-dose of corticosteroids and the development of complications. The primary endpoint was all-cause in-hospital mortality according to use of corticosteroids megadoses.
Results: Of a total of 14,921 patients, corticosteroids were used in 5,262 (35.3%). Of them, 2,216 (46%) specifically received megadoses. Age was a factor that differed between those who received megadoses therapy versus those who did not in a significant manner (69 years [IQR 59-79] vs 73 years [IQR 61-83]; p < .001). Radiological and analytical findings showed a higher use of megadoses therapy among patients with an interstitial infiltrate and elevated inflammatory markers associated with COVID-19. In the univariate study it appears that steroid use is associated with increased mortality (OR 2.07 95% CI 1.91-2.24 p < .001) and megadose use with increased survival (OR 0.84 95% CI 0.75-0.96, p 0.011), but when adjusting for possible confounding factors, it is observed that the use of megadoses is also associated with higher mortality (OR 1.54, 95% CI 1.32-1.80; p < .001). There is no difference between megadoses and low-dose (p .298). Although, there are differences in the use of megadoses versus low-dose in terms of complications, mainly infectious, with fewer pneumonias and sepsis in the megadoses group (OR 0.82 95% CI 0.71-0.95; p < .001 and OR 0.80 95% CI 0.65-0.97; p < .001) respectively.
Conclusion: There is no difference in mortality with megadoses versus low-dose, but there is a lower incidence of infectious complications with glucocorticoid megadoses.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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