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Clin Microbiol Infect . Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicenter study

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  • Clin Microbiol Infect . Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicenter study


    Clin Microbiol Infect


    . 2020 Sep 21;S1198-743X(20)30563-2.
    doi: 10.1016/j.cmi.2020.09.014. Online ahead of print.
    Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicenter study


    Michele Bartoletti 1 , Lorenzo Marconi 2 , Luigia Scudeller 3 , Livia Pancaldi 4 , Sara Tedeschi 4 , Maddalena Giannella 4 , Matteo Rinaldi 4 , Linda Bussini 4 , Ilaria Valentini 5 , Anna Filomena Ferravante 5 , Antonella Potalivo 6 , Elisa Marchionni 2 , Giacomo Fornaro 4 , Renato Pascale 4 , Zeno Pasquini 7 , Massimo Puoti 8 , Marco Merli 8 , Francesco Barchiesi 7 , Francesca Volpato 4 , Arianna Rubin 4 , Annalisa Saracino 9 , Tommaso Tonetti 10 , Paolo Gaibani 11 , Vito Marco Ranieri 10 , Pierluigi Viale 4 , Francesco Cristini 2 , PREDICO study group



    Collaborators, Affiliations

    Abstract

    Objectives: To assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19) METHODS: Multicenter observational study from February 22 through June 30, 2020. We included consecutive adult patients with severe COVID-19 defined as respiratory rate ≥30 breath per minute, oxygen saturation ≤93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ≤300 mmHg. We excluded patients treated with other immunomodulant drugs, receiving low dose of corticosteroids and those receiving corticosteroids after 72h from admission. The primary endpoint was 30-day mortality form hospital admission. The main exposure variable was corticosteroid therapy at dosage of ≥0.5 mg/kg of prednisone equivalents. It was introduced as binomial covariate in a logistic regression model for primary endpoint and inverse probability of treatment weighting using the propensity score.
    Results: Of 1717 patients with COVID-19 evaluated, 513 patients were included in the study; of these 170 (33%) were treated with corticosteroids. During the hospitalization 166 (34%) patients reached the primary outcome [60/170 (35%) in the corticosteroid group and 106/343 (31%) in the non-corticosteroid group]. At multivariable analysis corticosteroid treatment was not associated with lower 30-day mortality rate [aOR 0.59 (0.20-1.74), p=0.33]. After inverse probability of treatment weighting, corticosteroids were not associated to lower 30-day mortality [average treatment effect 0.05 (95% -0.02 to 0.09), p=0.12]. However, subgroup analysis revealed that in patients with PO2/FiO2 < 200 mmHg at admission [135 patients, 52 (38%) treated with corticosteroids] corticosteroid treatment was associated to a lower risk of 30-day mortality [23/52 (44%) vs 45/83 (54%), aOR 0.20 (95%CI 0.04 to 0.90), p=0.036].
    Conclusion: Our study shows that the effect of corticosteroid treatment on mortality might be limited to critically ill COVID-19 patients.

    Keywords: ARDS; COVID-19; SARS-CoV-2; corticosteroids; mortality.

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