A Retrospective Controlled Cohort Study of the Impact of Glucocorticoid Treatment in SARS-CoV-2 Infection Mortality

Autor: Ana Muñoz Gómez, Antonio Ramos Martínez, Belén Ruiz-Antorán, Elena Múñez Rubio, Concepción Payares-Herrera, Alejandro Callejas Díaz, Cristina Avendaño-Solá, Patricia Mills Sánchez, Aránzazu Sancho López, Gustavo Adolfo Centeno-Soto, Laura Delgado Téllez de Cepeda, Ana Fernández Cruz, Ángela Valencia Alijo, Amy Galán Gómez, Enrique Sánchez Chica, Ignacio Morrás de la Torre, Javier Gómez Irusta, Laura Javaloyes Garachana, Silvia Blanco Alonso
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Comorbidity
Azithromycin
030204 cardiovascular system & hematology
Lopinavir
Hospitals
University
0302 clinical medicine
Interquartile range
Neoplasms
Medicine
Pharmacology (medical)
030212 general & internal medicine
Hazard ratio
Middle Aged
Drug Combinations
Intensive Care Units
Infectious Diseases
Methylprednisolone
Cardiovascular Diseases
Drug Therapy
Combination
Female
Coronavirus Infections
steroids
Hydroxychloroquine
medicine.drug
Cohort study
medicine.medical_specialty
Pneumonia
Viral
Antiviral Agents
Drug Administration Schedule
Betacoronavirus
03 medical and health sciences
Internal medicine
Diabetes Mellitus
Humans
Pandemics
Aged
Dyslipidemias
Retrospective Studies
Pharmacology
Ritonavir
SARS-CoV-2
business.industry
COVID-19
Retrospective cohort study
Odds ratio
Length of Stay
Editor's Pick
medicine.disease
mortality
Survival Analysis
Confidence interval
Pneumonia
Interferons
business
Zdroj: Antimicrobial Agents and Chemotherapy
ISSN: 1098-6596
0066-4804
DOI: 10.1128/aac.01168-20
Popis: Evidence to support the use of steroids in coronavirus disease 2019 (COVID-19) pneumonia is lacking. We aim to determine the impact of steroid use for COVID-19 pneumonia on hospital mortality. We performed a single-center retrospective cohort study in a university hospital in Madrid, Spain, during March of 2020. To determine the role of steroids in in-hospital mortality, patients admitted with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia and treated with steroids were compared to patients not treated with steroids, and we adjusted with a propensity score for patients on steroid treatment.
Evidence to support the use of steroids in coronavirus disease 2019 (COVID-19) pneumonia is lacking. We aim to determine the impact of steroid use for COVID-19 pneumonia on hospital mortality. We performed a single-center retrospective cohort study in a university hospital in Madrid, Spain, during March of 2020. To determine the role of steroids in in-hospital mortality, patients admitted with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia and treated with steroids were compared to patients not treated with steroids, and we adjusted with a propensity score for patients on steroid treatment. Survival times were compared using the log rank test. Different steroid regimens were compared and adjusted with a second propensity score. During the study period, 463 out of 848 hospitalized patients with COVID-19 pneumonia fulfilled inclusion criteria. Among them, 396 (46.7%) patients were treated with steroids and 67 patients were not. Global mortality was 15.1%. The median time to steroid treatment from symptom onset was 10 days (interquartile range [IQR], 8 to 13 days). In-hospital mortality was lower in patients treated with steroids than in controls (13.9% [55/396] versus 23.9% [16/67]; hazard ratio [HR], 0.51 [95% confidence interval, 0.27 to 0.96]; P = 0.044). Steroid treatment reduced mortality by 41.8% relative to the mortality with no steroid treatment (relative risk reduction, 0.42 [95% confidence interval, 0.048 to 0.65]). Initial treatment with 1 mg/kg of body weight/day of methylprednisolone versus steroid pulses was not associated with in-hospital mortality (13.5% [42/310] versus 15.1% [13/86]; odds ratio [OR], 0.880 [95% confidence interval, 0.449 to 1.726]; P = 0.710). Our results show that the survival of patients with SARS-CoV-2 pneumonia is higher in patients treated with glucocorticoids than in those not treated. Rates of in-hospital mortality were not different between initial regimens of 1 mg/kg/day of methylprednisolone and glucocorticoid pulses.
Databáze: OpenAIRE
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