Second Week Methyl-Prednisolone Pulses Improve Prognosis in Patients with Severe Coronavirus Disease 2019 Pneumonia: an Observational Comparative Study Using Routine Care Data
| Autor: | Ruiz-Irastorza, Guillermo, Pijoan, Jose-Ignacio, Bereciartua, Elena, Dunder, Susanna, Dominguez-Cainzos, Jokin, Garcia-Escudero, Paula, Rodrigo, Alejandro, Gomez-Carballo, Carlota, Varona, Jimena, Guio, Laura, Ibarrola, Marta, Ugarte, Amaia, Martinez-Berriotxoa, Agustin, Cruces COVID Study Group |
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| Rok vydání: | 2020 |
| Předmět: |
Male
0301 basic medicine Viral Diseases Time Factors Pulmonology Epidemiology medicine.medical_treatment coronavirus Disease Cardiovascular Medicine medicine.disease_cause Steroid Therapy Medical Conditions 0302 clinical medicine Risk Factors Medicine and Health Sciences Intubation 030212 general & internal medicine Respiratory system Coronavirus Inflammatory diseases COVID-19 Medical risk factors Glucocorticoid therapy Cardiovascular disease risk Pneumonia Death rates education.field_of_study Multidisciplinary Pharmaceutics Middle Aged Prognosis Glucocorticoid Therapy Infectious Diseases Cardiovascular Diseases Medicine Female Coronavirus Infections Research Article Risk medicine.medical_specialty Coronavirus disease 2019 (COVID-19) Death Rates Inflammatory Diseases Science Pneumonia Viral 030106 microbiology Population Cardiology Surgical and Invasive Medical Procedures Methylprednisolone 03 medical and health sciences Drug Therapy Population Metrics Internal medicine Intubation Intratracheal medicine Humans pneumonia In patient education Glucocorticoids Pandemics Aged Retrospective Studies Inflammation Population Biology business.industry routine care data Biology and Life Sciences Covid 19 Retrospective cohort study Cardiovascular Disease Risk medicine.disease Oxygen Spain Medical Risk Factors Observational study business |
| Zdroj: | Addi. Archivo Digital para la Docencia y la Investigación instname PLOS ONE, 15(9):e0239401 PLoS ONE, Vol 15, Iss 9, p e0239401 (2020) Addi: Archivo Digital para la Docencia y la Investigación Universidad del País Vasco PLoS ONE |
| Popis: | OBJECTIVE: To analyze the effects of a short course of methyl-prednisolone pulses (MP) during the second week of disease (week-2) on the clinical course of patients with severe coronavirus disease 2019 (COVID-19) pneumonia. DESIGN: Comparative observational study using data collected from routine care. SETTING: Hospital Universitario Cruces, a tertiary level University hospital at Barakaldo, Bizkaia, Spain. PARTICIPANTS: All patients with COVID-19 pneumonia admitted between 1st March and 30th April 2020 to the services of Infectious Diseases and Internal Medicine. INTERVENTIONS: Treatment with week-2-MP (125-250 mg/d for 3 consecutive days with no subsequent tapering) vs. standard of care. MAIN OUTCOMES MEASURES: Time to death and time to death or endotracheal intubation. RESULTS: Two hundred and forty-two patients with confirmed COVID-19 pneumonia and elevated inflammatory markers at admission were included in the study. Sixty-one patients (25%) received week-2-MP. Twenty-two patients (9%) died during the study period. Thirty-one patients (12.8%) suffered death or intubation. The adjusted HR for death was 0.35 (95%CI 0.11 to 1.06, p= 0.064) for patients in the week-2-MP group. The adjusted HR for death or intubation week-2-MP was 0.33 (95%CI 0.13 to 0.84, p=0.020) for patients in the week-2-MP group. These differences were seen in the subcohort of patients with a SaO2/FiO2 at day 7 lower than the median of the whole population: HR 0.31, 95% CI 0.08 to 1.12, p=0.073 and HR 0.34, 95%CI 0.12 to 0.94, p=0.038, respectively, but not in patients with higher SaO2/FiO2. Other predictors of the final outcomes were arterial hypertension, SaO2/FiO2, high-risk CURB65 scores and the use of non-pulse glucocorticoids. Non-pulse glucocorticoids were a predictor of infections (OR 4.72, 95%CI 1.90 to 11.80, p |
| Databáze: | OpenAIRE |
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