tetano
Editor, Senior Moderator
Adv Med Sci
. 2021 Apr 24;66(2):262-268.
doi: 10.1016/j.advms.2021.04.002. Online ahead of print.
Role of the early short-course corticosteroids treatment in ARDS caused by COVID-19: A single-center, retrospective analysis
Lucio Boglione[SUP] 1 [/SUP], Carlo Olivieri[SUP] 2 [/SUP], Roberto Rostagno[SUP] 3 [/SUP], Federica Poletti[SUP] 3 [/SUP], Roberta Moglia[SUP] 3 [/SUP], Bianca Bianchi[SUP] 3 [/SUP], Maria Esposito[SUP] 3 [/SUP], Stefano Biffi[SUP] 3 [/SUP], Silvio Borr?[SUP] 3 [/SUP]
Affiliations
Abstract
Purpose: Severe coronavirus disease 2019 (COVID-19) is strongly related to interstitial pneumonia with frequent development of acute respiratory distress syndrome (ARDS). The role of corticosteroids (CS) treatment in these patients is still controversial. Some studies evidenced a possible role of an early short-term course of CS treatment in the treatment of severe pneumonia.
Patients and methods: This is a single-center, retrospective study considering the patients with confirmed COVID-19 pneumonia admitted to our hospital between 9th March and 15[SUP]th[/SUP] June 2020. Two groups were considered: early high-dose of methyl-prednisolone (eHDM; n ?= ?31) and the control group (n ?= ?52). Patients in the eHDM group received the dose of 5-8 ?mg/kg/day of methyl-prednisolone for 2 consecutive days. Primary outcome was the mortality evaluation; secondary outcomes were clinical improvement, side-effects and laboratory/radiographic changes.
Results: Significant differences between the two groups were: length of hospitalization (21.5 vs 28.4 days, p ?= ?0.026), length of non-invasive ventilation (NIV) or mechanical ventilation (11.5 vs 14.5 days, p ?= ?0.031), death (5 vs 12, p ?= ?0.006) and clinical improvement (16 vs 11, p=0.018). The following factors were related to in-hospital mortality in the multivariate analysis: comorbidities (OR ?= ?2.919; 95%CI ?= ?1.515-16.705; p<0.001), days from the onset of symptoms and the hospital admission (OR ?= ?1.404; 95%CI ?= ?1.069-12.492; p ?= ?0.011), PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] (P/F) ratio (OR ?= ?3.111; 95%CI ?= ?2.334-16.991; p ?= ?0.009) and eHDM treatment (OR ?= ?0.741; 95%CI ?= ?0.129-0.917; p ?= ?0.007).
Conclusion: The eHDM is an interesting and promising approach in the ARDS related to COVID-19 pneumonia, which reduces mortality, length of hospitalization and the need for mechanical ventilation.
Keywords: ARDS; COVID-19; Corticosteroids; Early treatment; SARS-CoV-2.
. 2021 Apr 24;66(2):262-268.
doi: 10.1016/j.advms.2021.04.002. Online ahead of print.
Role of the early short-course corticosteroids treatment in ARDS caused by COVID-19: A single-center, retrospective analysis
Lucio Boglione[SUP] 1 [/SUP], Carlo Olivieri[SUP] 2 [/SUP], Roberto Rostagno[SUP] 3 [/SUP], Federica Poletti[SUP] 3 [/SUP], Roberta Moglia[SUP] 3 [/SUP], Bianca Bianchi[SUP] 3 [/SUP], Maria Esposito[SUP] 3 [/SUP], Stefano Biffi[SUP] 3 [/SUP], Silvio Borr?[SUP] 3 [/SUP]
Affiliations
- PMID: 34022675
- DOI: 10.1016/j.advms.2021.04.002
Abstract
Purpose: Severe coronavirus disease 2019 (COVID-19) is strongly related to interstitial pneumonia with frequent development of acute respiratory distress syndrome (ARDS). The role of corticosteroids (CS) treatment in these patients is still controversial. Some studies evidenced a possible role of an early short-term course of CS treatment in the treatment of severe pneumonia.
Patients and methods: This is a single-center, retrospective study considering the patients with confirmed COVID-19 pneumonia admitted to our hospital between 9th March and 15[SUP]th[/SUP] June 2020. Two groups were considered: early high-dose of methyl-prednisolone (eHDM; n ?= ?31) and the control group (n ?= ?52). Patients in the eHDM group received the dose of 5-8 ?mg/kg/day of methyl-prednisolone for 2 consecutive days. Primary outcome was the mortality evaluation; secondary outcomes were clinical improvement, side-effects and laboratory/radiographic changes.
Results: Significant differences between the two groups were: length of hospitalization (21.5 vs 28.4 days, p ?= ?0.026), length of non-invasive ventilation (NIV) or mechanical ventilation (11.5 vs 14.5 days, p ?= ?0.031), death (5 vs 12, p ?= ?0.006) and clinical improvement (16 vs 11, p=0.018). The following factors were related to in-hospital mortality in the multivariate analysis: comorbidities (OR ?= ?2.919; 95%CI ?= ?1.515-16.705; p<0.001), days from the onset of symptoms and the hospital admission (OR ?= ?1.404; 95%CI ?= ?1.069-12.492; p ?= ?0.011), PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] (P/F) ratio (OR ?= ?3.111; 95%CI ?= ?2.334-16.991; p ?= ?0.009) and eHDM treatment (OR ?= ?0.741; 95%CI ?= ?0.129-0.917; p ?= ?0.007).
Conclusion: The eHDM is an interesting and promising approach in the ARDS related to COVID-19 pneumonia, which reduces mortality, length of hospitalization and the need for mechanical ventilation.
Keywords: ARDS; COVID-19; Corticosteroids; Early treatment; SARS-CoV-2.