High versus standard doses of corticosteroids in severe COVID-19: a retrospective cohort study
- PDF / 432,872 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 0 Downloads / 177 Views
ORIGINAL ARTICLE
High versus standard doses of corticosteroids in severe COVID-19: a retrospective cohort study Enric Monreal 1 & Susana Sainz de la Maza 1 & Elena Natera-Villalba 1 & Álvaro Beltrán-Corbellini 1 & Fernando Rodríguez-Jorge 1 & Jose Ignacio Fernández-Velasco 2 & Paulette Walo-Delgado 2 & Alfonso Muriel 3 & Javier Zamora 3 & Araceli Alonso-Canovas 1 & Jesús Fortún 4 & Luis Manzano 5 & Beatriz Montero-Errasquín 6 & Lucienne Costa-Frossard 1 & Jaime Masjuan 1 & Luisa María Villar 2 & for the COVID-HRC group Received: 2 September 2020 / Accepted: 16 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Despite the increasing evidence of the benefit of corticosteroids for the treatment of moderate-severe coronavirus disease 2019 (COVID-19) patients, no data are available about the potential role of high doses of steroids for these patients. We evaluated the mortality, the risk of need for mechanical ventilation (MV), or death and the risk of developing a severe acute respiratory distress syndrome (ARDS) between high (HD) and standard doses (SD) among patients with a severe COVID-19. All consecutive confirmed COVID-19 patients admitted to a single center were selected, including those treated with steroids and an ARDS. Patients were allocated to the HD (≥ 250 mg/day of methylprednisolone) of corticosteroids or the SD (≤ 1.5 mg/kg/day of methylprednisolone) at discretion of treating physician. Five hundred seventy-three patients were included: 428 (74.7%) men, with a median (IQR) age of 64 (54–73) years. In the HD group, a worse baseline respiratory situation was observed and male gender, older age, and comorbidities were significantly more common. After adjusting by baseline characteristics, HDs were associated with a higher mortality than SD (adjusted OR 2.46, 95% CI 1.59–3.81, p < 0.001) and with an increased risk of needing MV or death (adjusted OR 2.35, p = 0.001). Conversely, the risk of developing a severe ARDS was similar between groups. Interaction analysis showed that HD increased mortality exclusively in elderly patients. Our real-world experience advises against exceeding 1–1.5 mg/kg/day of corticosteroids for severe COVID-19 with an ARDS, especially in older subjects. This reinforces the rationale of modulating rather than suppressing immune responses in these patients. Keywords COVID-19 . Severe acute respiratory syndrome coronavirus 2 . SARS-CoV-2 . Corticosteroids
Introduction Coronavirus disease 2019 (COVID-19) is a respiratory infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel emergent virus that was first
recognized in Wuhan, China, and has since rapidly spread around the world [1]. Although most patients present a mild-moderate disease, almost one-third of patients are at high risk of developing a more severe disease due to an acute respiratory distress
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10096-020-04078-1) contains supplementary material, which is avail
Data Loading...
