Int J Infect Dis . Determinants of the protective effect of glucocorticoids on mortality in hospitalized patients with COVID-19: Insights from the Cardio-COVID-Italy multicenter study

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Int J Infect Dis


. 2021 May 27;S1201-9712(21)00458-6.
doi: 10.1016/j.ijid.2021.05.056. Online ahead of print.
Determinants of the protective effect of glucocorticoids on mortality in hospitalized patients with COVID-19: Insights from the Cardio-COVID-Italy multicenter study


Matteo Pagnesi ¹ , Riccardo M Inciardi ¹ , Carlo Mario Lombardi ¹ , Piergiuseppe Agostoni ² , Pietro Ameri ³ , Lucia Barbieri ⁴ , Antonio Bellasi ⁵ , Rita Camporotondo ⁶ , Claudia Canale ³ , Valentina Carubelli ¹ , Stefano Carugo ⁷ , Francesco Catagnano ⁸ , Laura A Dalla Vecchia ⁹ , Gian Battista Danzi ¹⁰ , Mattia Di Pasquale ¹ , Margherita Gaudenzi ² , Stefano Giovinazzo ³ , Massimiliano Gnecchi ⁶ , Marco Guazzi ¹¹ , Annamaria Iorio ¹² , Maria Teresa La Rovere ¹³ , Sergio Leonardi ⁶ , Gloria Maccagni ¹⁰ , Massimo Mapelli ² , Davide Margonato ⁸ , Marco Merlo ¹⁴ , Luca Monzo ¹⁵ , Andrea Mortara ¹⁶ , Vincenzo Nuzzi ¹⁴ , Massimo Piepoli ¹⁷ , Italo Porto ³ , Andrea Pozzi ¹² , Filippo Sarullo ¹⁸ , Gianfranco Sinagra ¹⁴ , Chiara Tedino ¹ , Daniela Tomasoni ¹ , Maurizio Volterrani ¹⁹ , Gregorio Zaccone ¹ , Michele Senni ¹² , Marco Metra ²⁰



Affiliations

• PMID: 34052406
• PMCID: PMC8159705
• DOI: 10.1016/j.ijid.2021.05.056

Free PMC article

Abstract

Background: Glucocorticoid therapy has emerged as an effective therapeutic option in hospitalized patients with coronavirus disease 2019 (COVID-19). Our aim was to focus on the impact of relevant clinical and laboratory factors on the protective effect of glucocorticoids on mortality.
Methods: We performed a sub-analysis of the multicenter Cardio-COVID-Italy registry, enrolling consecutive patients with COVID-19 admitted to 13 Italian cardiology units between March 1^st, 2020, and April 9^th, 2020. The primary endpoint was in-hospital mortality.
Results: A total of 706 COVID-19 patients were included (n = 349 treated with glucocorticoids, n = 357 not treated with glucocorticoids). After adjustment for relevant covariates, use of glucocorticoids was associated with a lower risk of in-hospital mortality (adjusted HR 0.44, 95% CI 0.26-0.72, p = 0.001). A significant interaction was observed between the protective effect of glucocorticoids on mortality and PaO₂/FiO₂ ratio on admission (p = 0.042), oxygen saturation on admission (p = 0.017), and peak CRP (0.023). Such protective effect of glucocorticoids was mainly observed in patients with lower PaO₂/FiO₂ ratio (<300), lower oxygen saturation (<90%), and higher CRP (>100 mg/L).
Conclusions: The protective effects of glucocorticoids on mortality in COVID-19 was more evident among patients of worse respiratory parameters and higher systemic inflammation.

Keywords: COVID-19; SARS-CoV-2; corticosteroid; glucocorticoid; steroid.