Methylprednisolone and 60 Days in Hospital Survival in Coronavirus Disease 2019 Pneumonia
Autor: | Sung Hung, Waqas Rahman, Khurram Sarfraz, Yukiko Oe, Joshua Josephs, Justin J. Panthappattu, Steven J. Sperber, Sean Sadikot, Sapan Shah, Ronaldo C. Go, Karan Omidvari, Hyun Im, Themba Nyirenda, Lesley Philip, Anuja Pradhan, Sophia Dar, Michael Marafelias, DO Chandni Bheeman, Roshan Shah, DO Neel Shah, Keith M. Rose |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
medicine.medical_specialty
Combination therapy medicine.medical_treatment Gastroenterology Coronary artery disease coronavirus disease 2019 Internal medicine medicine pneumonia Original Clinical Report Mechanical ventilation RC86-88.9 Proportional hazards model business.industry Hazard ratio Medical emergencies. Critical care. Intensive care. First aid General Medicine acute respiratory distress syndrome medicine.disease methylprednisolone Pneumonia Methylprednisolone ComputingMethodologies_DOCUMENTANDTEXTPROCESSING Erratum business medicine.drug Cohort study |
Zdroj: | Critical Care Explorations Crit Care Explor Critical Care Explorations, Vol 3, Iss 7, p e0493 (2021) |
ISSN: | 2639-8028 |
Popis: | Supplemental Digital Content is available in the text. OBJECTIVES: To determine methylprednisolone’s dose, duration, and administration from onset of symptoms and association with 60 days in hospital survival of coronavirus disease 2019 pneumonia. DESIGN: Cohort study. SETTING: Thirteen hospitals in New Jersey, United States during March to June 2020. PATIENTS: Seven-hundred fifty-nine hospitalized coronavirus disease 2019 patients. INTERVENTIONS: We performed a propensity matched cohort study between patients who received methylprednisolone and no methylprednisolone. Patients in the methylprednisolone group were further differentiated into dose (high dose and low dose), duration, and administration from onset of symptoms. MEASUREMENTS AND MAIN RESULTS: In the propensity matched sample, 99 out of 380 (26%) in no methylprednisolone, 69 out of 215 (31.9%) in low-dose methylprednisolone, and 74 out of 164 (55.2%) high-dose methylprednisolone expired. Overall median survival for no methylprednisolone (25.0 d), low-dose methylprednisolone (39.0 d), high-dose methylprednisolone (20.0 d), less than or equal to 7 days duration (19.0 d), 7–14 days duration (30.0 d), greater than 14 days duration (44.0 d), onset of symptoms less than or equal to 7 days (20.0 d), and onset of symptoms 7–14 days (27.0 d) were statistically significant (log-rank p ≤ 0.001). Multivariate Cox regression showed nursing home residents, coronary artery disease, and invasive mechanical ventilation were independently associated with mortality. Methylprednisolone was associated with reduced mortality compared with no methylprednisolone (hazard ratio, 0.40; 95% CI, 0.27–0.59; p < 0.001) but no added benefit with high dose. Low-dose methylprednisolone for 7–14 days was associated with reduced mortality compared with less than or equal to 7 days (hazard ratio, 0.45; 95% CI, 0.22–0.91; p = 0.0273), and no additional benefit if greater than 14 days (hazard ratio, 1.27; 95% CI, 0.60–2.69; p = 0.5434). Combination therapy with tocilizumab was associated with reduced mortality over monotherapy (p < 0.0116). CONCLUSIONS: Low-dose methylprednisolone was associated with reduced mortality if given greater than 7 days from onset of symptoms, and no additional benefit greater than 14 days. High dose was associated with higher mortality. |
Databáze: | OpenAIRE |
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