Efficacy of corticosteroids in non-intensive care unit patients with COVID-19 pneumonia from the New York Metropolitan region

Autor: Kuldeep Ghosh, Joanna Lenik, Hossam Amin, Monil Majmundar, Rajkumar Doshi, Imnett Habtes, Tikal Kansara, Hansang Park, Shobhana Chaudhari, Ashish Kumar, Palak Shah
Rok vydání: 2020
Předmět:
0301 basic medicine
Male
Viral Diseases
Pulmonology
Epidemiology
medicine.medical_treatment
Kaplan-Meier Estimate
Steroid Therapy
law.invention
Medical Conditions
0302 clinical medicine
law
Adrenal Cortex Hormones
Medicine and Health Sciences
Intubation
030212 general & internal medicine
Hospital Mortality
Immune Response
Respiratory Distress Syndrome
Multidisciplinary
Pharmaceutics
Hazard ratio
Middle Aged
Intensive care unit
Hospitals
Chemistry
Intensive Care Units
Infectious Diseases
Treatment Outcome
Physical Sciences
Cohort
Medicine
Corticosteroid
Female
Coronavirus Infections
Research Article
Chemical Elements
Adult
medicine.medical_specialty
medicine.drug_class
Corticosteroid Therapy
Science
Immunology
Pneumonia
Viral
New York
Surgical and Invasive Medical Procedures
Lower risk
03 medical and health sciences
Betacoronavirus
Signs and Symptoms
Drug Therapy
Internal medicine
medicine
Humans
Pandemics
Aged
Proportional Hazards Models
Retrospective Studies
Inflammation
Proportional hazards model
business.industry
SARS-CoV-2
COVID-19
Medical risk factors
Corticosteroid therapy
Intensive care units
Pneumonia
Oxygen
Biology and Life Sciences
Covid 19
Retrospective cohort study
medicine.disease
Health Care
030104 developmental biology
Health Care Facilities
Medical Risk Factors
Clinical Medicine
business
Zdroj: PLoS ONE, Vol 15, Iss 9, p e0238827 (2020)
PLoS ONE
PLOS ONE, 15(9):e0238827
ISSN: 1932-6203
Popis: IntroductionThe role of systemic corticosteroid as a therapeutic agent for patients with COVID-19 pneumonia is controversial.ObjectiveThe purpose of this study was to evaluate the effect of corticosteroids in non-intensive care unit (ICU) patients with COVID-19 pneumonia complicated by acute hypoxemic respiratory failure (AHRF).MethodsThis was a single-center retrospective cohort study, from the 16th March, 2020 to 30th April, 2020; final follow-up on 10th May, 2020. 265 patients consecutively admitted to the non-ICU wards with laboratory-confirmed COVID-19 pneumonia were screened for inclusion. 205 patients who developed AHRF (SpO2/FiO2 ≤ 440 or PaO2/FiO2 ≤ 300) were only included in the final study. Direct admission to the Intensive care unit (ICU), patients developing composite primary outcome within 24 hours of admission, and patients who never became hypoxic during their stay in the hospital were excluded. Patients divided into two cohort based on corticosteroid. The primary outcome was a composite of ICU transfer, intubation, or in-hospital mortality. Secondary outcomes were ICU transfer, intubation, in-hospital mortality, discharge, length of stay and daily trend of SpO2/FiO2 (SF) ratio from the index date. Cox-proportional hazard regression was implemented to analyze the time to event outcomes.ResultAmong 205 patients, 60 (29.27%) were treated with corticosteroid. The mean age was ∼57 years, and ∼75% were men. Thirteen patients (22.41%) developed a primary composite outcome in the corticosteroid cohort vs. 54 (37.5%) patients in the non-corticosteroid cohort (P=0.039). The adjusted hazard ratio (HR) for the development of the composite primary outcome was 0.15 (95% CI, 0.07 – 0.33; P 2/FiO2 over time compared to the non-corticosteroid cohort who experience decreasing SpO2/FiO2 over time.ConclusionAmong non-ICU patients hospitalized with COVID-19 pneumonia complicated by AHRF, treatment with corticosteroid was associated with a significantly lower risk of the primary composite outcome of ICU transfer, intubation, or in-hospital death.
Databáze: OpenAIRE
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