Biomarker-Concordant Steroid Administration in Severe Coronavirus Disease-2019.

Autor:	Tekin A; Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA., Domecq JP; Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA., Valencia Morales DJ; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA., Surapeneni KM; Departments of Biochemistry, Molecular Virology, Research and Clinical Skills & Simulation, Panimalar Medical College Hospital & Research Institute, Chennai, Tamil Nadu, India., Zabolotskikh IB; Department of Anesthesiology, Intensive Care Medicine and Transfusiology, Kuban State Medical University with affiliation Territorial Hospital #2, Krasnodar, Russia., Cartin-Ceba R; Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA., Clevenbergh P; Infectious Diseases Clinic, CHU Brugmann, ULB, Brussels, Belgium., Mesland JB; Intensive Care Department, Centre Hospitalier Jolimont, La Louvière, Belgium., Claure-Del Granado R; Department of Medicine, Clínica Los Olivos, Cochabamba, Bolivia., Gavidia OY; Clinica Medical SAS, Colombia., Kumar VK; Society of Critical Care Medicine, Mount Prospect, IL, USA., Kashyap R; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA., Walkey AJ; Pulmonary Center, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Evans Center of Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston, MA, USA., Gajic O; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA., Odeyemi Y; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
Jazyk:	angličtina
Zdroj:	Journal of intensive care medicine [J Intensive Care Med] 2023 Nov; Vol. 38 (11), pp. 1003-1014. Date of Electronic Publication: 2023 May 24.
DOI:	10.1177/08850666231177200
Abstrakt:	Background: Although corticosteroids have become the standard of care for patients with coronavirus disease-2019 (COVID-19) on supplemental oxygen, there is growing evidence of differential treatment response. This study aimed to evaluate if there was an association between biomarker-concordant corticosteroid treatment and COVID-19 outcomes. Methods: This registry-based cohort study included adult COVID-19 hospitalized patients between January 2020 and December 2021 from 109 institutions. Patients with available C-reactive protein (CRP) levels within 48 h of admission were evaluated. Those on steroids before admission, stayed in the hospital for <48 h, or were not on oxygen support were excluded. Corticosteroid treatment was biomarker-concordant if given with high baseline CRP ≥150 mg/L or withheld with low CRP (<150 mg/L) and vice-versa was considered discordant (low CRP with steroids, high CRP without steroids). Hospital mortality was the primary outcome. Sensitivity analyses were conducted using varying CRP level thresholds. The model interaction was tested to determine steroid effectiveness with increasing CRP levels. Results: Corticosteroid treatment was biomarker-concordant in 1778 (49%) patients and discordant in 1835 (51%). The concordant group consisted of higher-risk patients than the discordant group. After adjusting for covariates, the odds of in-hospital mortality were significantly lower in the concordant group than the discordant (odds ratio [95% confidence interval (C.I.)] = 0.71 [0.51, 0.98]). Similarly, adjusted mortality difference was significant at the CRP thresholds of 100 and 200 mg/L (odds ratio [95% C.I.] = 0.70 [0.52, 0.95] and 0.57 [0.38, 0.85], respectively), and concordant steroid use was associated with lower need for invasive ventilation for 200 mg/L threshold (odds ratio [95% C.I.] = 0.52 [0.30, 0.91]). In contrast, no outcome benefit was observed at CRP threshold of 50. When the model interaction was tested, steroids were more effective at reducing mortality as CRP levels increased. Conclusion: Biomarker-concordant corticosteroid treatment was associated with lower odds of in-hospital mortality in severe COVID-19. Competing Interests: Declaration of Conflicting InterestsR.K. receives funding from the National Institutes of Health/National Heart, Lung and Blood Institute: R01HL 130881, UG3/UH3HL 141722; Gordon and Betty Moore Foundation, and Janssen Research & Development, LLC; and royalties from Ambient Clinical Analytics. Inc. They had no influence on the acquisition, analysis, interpretation, and reporting of pooled data for this manuscript. AJW receives funding from the National Institutes of Health/National Heart, Lung and Blood Institute grants R01HL151607, R01HL139751, Agency of Healthcare Research and Quality, R01HS026485, Department of Defense CP200036, and royalties from UpToDate. OG receives funding from the Agency of Healthcare Research and Quality R18HS 26609-2, National Institutes of Health/National Heart, Lung and Blood Institute: R01HL 130881, UG3/UH3HL 141722; Department of Defense DOD W81XWH; American Heart Association Rapid Response Grant—COVID-19; and royalties from Ambient Clinical Analytics. Inc. These funds had no influence on acquisition, analysis, interpretation and reporting of pooled data for this manuscript.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu