Early Short-Course Corticosteroids in Hospitalized Patients With COVID-19
| Autor: | Fadel, Raef, Morrison, Austin R, Vahia, Amit, Smith, Zachary R, Chaudhry, Zohra, Bhargava, Pallavi, Miller, Joseph, Kenney, Rachel M, Alangaden, George, Ramesh, Mayur S, Nauriyal, Varidhi, Lakshmikanth, Jayanth, Abdul Hamed, Asif, Nadeem, Owais, Griebe, Kristin, Johnson, Joseph M, Bradley, Patrick, Uduman, Junior, Hegab, Sara, Swiderek, Jennifer, Godfrey, Amanda, Jennings, Jeffrey, Gardner-Gray, Jayna, Ackerman, Adam, Lezotte, Jonathan, Ruhala, Joseph, Samuel, Linoj, Tibbetts, Robert J, Brar, Indira, McKinnon, John, Suleyman, Geehan, Yared, Nicholas, Herc, Erica, Williams, Jonathan, Lanfranco, Odaliz Abreu, Chen, Anne, Zervos, Marcus, Scher, Eric |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Microbiology (medical) medicine.medical_specialty Coronavirus disease 2019 (COVID-19) Hospitalized patients medicine.drug_class medicine.medical_treatment coronavirus SARS-COV-2 030204 cardiovascular system & hematology outcomes Methylprednisolone law.invention 03 medical and health sciences 0302 clinical medicine law Adrenal Cortex Hormones Internal medicine medicine Major Article Corticosteroids Humans Multicenter Studies as Topic In patient Short course 030212 general & internal medicine Mechanical ventilation Adult patients business.industry Disease progression COVID-19 Odds ratio Middle Aged Intensive care unit Confidence interval COVID-19 Drug Treatment Clinical trial Hospitalization AcademicSubjects/MED00290 Infectious Diseases Corticosteroid Female business medicine.drug |
| Zdroj: | Clinical Infectious Diseases Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1093/cid/ciaa601 |
| Popis: | Background There is no proven antiviral or immunomodulatory therapy for coronavirus disease 2019 (COVID-19). The disease progression associated with the proinflammatory host response prompted us to examine the role of early corticosteroid therapy in patients with moderate to severe COVID-19. Methods We conducted a single pretest, single posttest quasi-experiment in a multicenter health system in Michigan from 12 March to 27 March 2020. Adult patients with confirmed moderate to severe COVID were included. A protocol was implemented on 20 March 2020 using early, short-course, methylprednisolone 0.5 to 1 mg/kg/day divided in 2 intravenous doses for 3 days. Outcomes of standard of care (SOC) and early corticosteroid groups were evaluated, with a primary composite endpoint of escalation of care from ward to intensive care unit (ICU), new requirement for mechanical ventilation, and mortality. All patients had at least 14 days of follow-up. Results We analyzed 213 eligible subjects, 81 (38%) and 132 (62%) in SOC and early corticosteroid groups, respectively. The composite endpoint occurred at a significantly lower rate in the early corticosteroid group (34.9% vs 54.3%, P = .005). This treatment effect was observed within each individual component of the composite endpoint. Significant reduction in median hospital length of stay was also observed in the early corticosteroid group (5 vs 8 days, P < .001). Multivariate regression analysis demonstrated an independent reduction in the composite endpoint at 14-days controlling for other factors (adjusted odds ratio: 0.41; 95% confidence interval, .22 – .77). Conclusions An early short course of methylprednisolone in patients with moderate to severe COVID-19 reduced escalation of care and improved clinical outcomes. Clinical Trials Registration NCT04374071. |
| Databáze: | OpenAIRE |
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