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Biomedicines . Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients Treated with Standard Dose of Dexamethasone or High Dose of Methylprednisolone

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  • Biomedicines . Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients Treated with Standard Dose of Dexamethasone or High Dose of Methylprednisolone


    Biomedicines


    . 2022 Jun 29;10(7):1548.
    doi: 10.3390/biomedicines10071548.
    Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients Treated with Standard Dose of Dexamethasone or High Dose of Methylprednisolone


    Alessandro Russo 1 , Chiara Davoli 1 , Cristian Borrazzo 2 , Vincenzo Olivadese 1 , Giancarlo Ceccarelli 2 , Paolo Fusco 1 , Alessandro Lazzaro 2 , Rosaria Lionello 1 , Marco Ricchio 1 , Francesca Serapide 1 , Bruno Tassone 1 , Elio Gentilini Cacciola 2 , Claudio Maria Mastroianni 2 , Carlo Torti 1 , Gabriella d'Ettorre 2 , Enrico Maria Trecarichi 1



    Affiliations

    Abstract

    The hyperinflammatory phase represents the main cause for the clinical worsening of acute respiratory distress syndrome (ARDS) in Coronavirus disease 2019 (COVID-19), leading to the hypothesis that steroid therapy could be a mainstream treatment in COVID-19 patients. This is an observational study including all consecutive patients admitted to two Italian University Hospitals for COVID-19 from March 2020 to December 2021. The aim of this study was to describe clinical characteristics and outcome parameters of hospitalized COVID-19 patients treated with dexamethasone 6 mg once daily (standard-dose group) or methylprednisolone 40 mg twice daily (high-dose group). The primary outcome was the impact of these different steroid treatments on 30-day mortality. During the study period, 990 patients were evaluated: 695 (70.2%) receiving standard dosage of dexamethasone and 295 (29.8%) receiving a high dose of methylprednisolone. Cox regression analysis showed that chronic obstructive pulmonary disease (HR 1.98, CI95% 1.34-9.81, p = 0.002), chronic kidney disease (HR 5.21, CI95% 1.48-22.23, p = 0.001), oncologic disease (HR 2.81, CI95% 1.45-19.8, p = 0.005) and high-flow nasal cannula, continuous positive airway pressure or non-invasive ventilation oxygen therapy (HR 61.1, CI95% 5.12-511.1, p < 0.001) were independently associated with 30-day mortality; conversely, high-dose steroid therapy was associated with survival (HR 0.42, CI95% 0.38-0.86, p = 0.002) at 30 days. Kaplan-Meier curves for 30-day survival displayed a statistically significant better survival rate in patients treated with high-dose steroid therapy (p = 0.018). The results of this study highlighted that the use of high-dose methylprednisolone, compared to dexamethasone 6 mg once daily, in hospitalized patients with COVID-19 may be associated with a significant reduction in mortality.

    Keywords: COVID-19; SARS-CoV-2; dexamethasone; methylprednisolone; mortality.

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