Med Clin (Engl Ed) . Association between high-dose steroid therapy, respiratory function, and time to discharge in patients with COVID-19: Cohort study

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Med Clin (Engl Ed)


. 2020 Nov 27.
doi: 10.1016/j.medcle.2020.08.001. Online ahead of print.
Association between high-dose steroid therapy, respiratory function, and time to discharge in patients with COVID-19: Cohort study


Alejandro Rodr?guez-Molinero ¹ , Carlos P?rez-L?pez ² , C?sar G?lvez-Barr?n ¹ , Antonio Mi?arro ³ , Ezequiel A Rodr?guez Gullello ¹ , Isabel Collado P?rez ¹ , N?ria Mil? R?fols ¹ , Ernesto E M?naco ¹ , Antonio Hidalgo Garc?a ¹ , Gemma A?a?os Carrasco ¹ , Antonio Chamero Pastilla ¹ , en representaci?n del grupo de investigadores para la COVID-19 del Consorci Sanitari de l’Alt Pened?s i Garraf (CSAPG)



Collaborators, Affiliations

• PMID: 33263084
• PMCID: PMC7691846
• DOI: 10.1016/j.medcle.2020.08.001

Abstract

in English, Spanish
Objective: To analyze whether there is an association between the use glucocorticoids at high doses, and the evolution of saturation/fraction of inspired oxygen (SAFI) or time to discharge, in patients hospitalized with COVID-19.
Methods: This was an observational study on a cohort of 418 patients admitted to three regional hospitals in Catalonia, Spain. As primary outcomes, we studied the evolution of SAFI in the first 48 h of treatment and the time to discharge. The results were compared between patients treated and untreated with glucocorticoids (methylprednisolone 1 mg/kg/day o dexamethasone 20-40 mg/day) through sub-cohort analyses matched for multiple clinical and prognostic factors, as well as through Cox multivariate models adjusted for prognostic factors. The simultaneous use of different treatments for COVID-19 was taken into account, both in sub-cohorts matching and in COX regression.
Results: There were 187 patients treated with glucocorticoids; of these, 25 patients could be matched with an equivalent number of control patients. In the analysis of these matched sub-cohorts, no significant difference was observed in time to discharge (log-rank: p = 0.291) or the increment in SAFI at 48 hours of treatment (glucocorticoides: -0.04; controls: +0.37; p = 0.095). Multivariate models using Cox regression showed a significantly longer time to discharge in patients treated with glucocorticoids (hazard ratio: 7.26; 95% IC: 3.30-15.95).
Conclusions: We have not found improvement in respiratory function or time until discharge, associated with the use of glucocorticoids at high doses.

Keywords: COVID-19; Coronavirus; Dexamethasone; Glucocorticoids; Methylprednisolone; SARS-CoV-2.