tetano
Editor, Senior Moderator
BMC Pulm Med
. 2023 Aug 28;23(1):315.
doi: 10.1186/s12890-023-02603-4. Evaluation of the use of methylprednisolone and dexamethasone in asthma critically ill patients with COVID-19: a multicenter cohort study
Khalid Al Sulaiman[SUP] 1 2 3 4 [/SUP], Ohoud Aljuhani[SUP] 5 [/SUP], Ghazwa B Korayem[SUP] 6 [/SUP], Ali Altebainawi[SUP] 7 [/SUP], Reham Alharbi[SUP] 8 [/SUP], Maha Assadoon[SUP] 9 [/SUP], Ramesh Vishwakarma[SUP] 10 [/SUP], Nadia H Ismail[SUP] 11 12 [/SUP], Asma A Alshehri[SUP] 13 [/SUP], Faisal E Al Mutairi[SUP] 9 [/SUP], Mashael AlFaifi[SUP] 14 [/SUP], Abdullah F Alharthi[SUP] 15 [/SUP], Abeer A Alenazi[SUP] 13 [/SUP], Mai Alalawi[SUP] 16 [/SUP], Omar Al Zumai[SUP] 17 18 19 [/SUP], Hussain Al Haji[SUP] 20 18 19 [/SUP], Sarah T Al Dughaish[SUP] 21 [/SUP], Abdulrahman S Alawaji[SUP] 17 [/SUP], Haifa A Alhaidal[SUP] 17 20 [/SUP], Ghassan Al Ghamdi[SUP] 20 22 23 [/SUP]
Affiliations
Background: Previous studies have shown mortality benefits with corticosteroids in Coronavirus disease-19 (COVID-19). However, there is inconsistency regarding the use of methylprednisolone over dexamethasone in COVID-19, and this has not been extensively evaluated in patients with a history of asthma. This study aims to investigate and compare the effectiveness and safety of methylprednisolone and dexamethasone in critically ill patients with asthma and COVID-19.
Methods: The primary endpoint was the in-hospital mortality. Other endpoints include 30-day mortality, respiratory failure requiring mechanical ventilation (MV), acute kidney injury (AKI), acute liver injury, length of stay (LOS), ventilator-free days (VFDs), and hospital-acquired infections. Propensity score (PS) matching, and regression analyses were used.
Results: A total of one hundred-five patients were included. Thirty patients received methylprednisolone, whereas seventy-five patients received dexamethasone. After PS matching (1:1 ratio), patients who received methylprednisolone had higher but insignificant in-hospital mortality in both crude and logistic regression analysis, [(35.0% vs. 18.2%, P = 0.22) and (OR 2.31; CI: 0.56 - 9.59; P = 0.25), respectively]. There were no statistically significant differences in the 30-day mortality, respiratory failure requiring MV, AKI, acute liver injury, ICU LOS, hospital LOS, and hospital-acquired infections.
Conclusions: Methylprednisolone in COVID-19 patients with asthma may lead to increased in-hospital mortality and shorter VFDs compared to dexamethasone; however, it failed to reach statistical significance. Therefore, it is necessary to interpret these data cautiously, and further large-scale randomized clinical trials are needed to establish more conclusive evidence and support these conclusions.
Keywords: Asthma; COVID-19; Critically ill; Dexamethasone; Intensive Care Units; Length of stay (LOS); MV duration; Methylprednisolone; Mortality; SARS-CoV-2.
. 2023 Aug 28;23(1):315.
doi: 10.1186/s12890-023-02603-4. Evaluation of the use of methylprednisolone and dexamethasone in asthma critically ill patients with COVID-19: a multicenter cohort study
Khalid Al Sulaiman[SUP] 1 2 3 4 [/SUP], Ohoud Aljuhani[SUP] 5 [/SUP], Ghazwa B Korayem[SUP] 6 [/SUP], Ali Altebainawi[SUP] 7 [/SUP], Reham Alharbi[SUP] 8 [/SUP], Maha Assadoon[SUP] 9 [/SUP], Ramesh Vishwakarma[SUP] 10 [/SUP], Nadia H Ismail[SUP] 11 12 [/SUP], Asma A Alshehri[SUP] 13 [/SUP], Faisal E Al Mutairi[SUP] 9 [/SUP], Mashael AlFaifi[SUP] 14 [/SUP], Abdullah F Alharthi[SUP] 15 [/SUP], Abeer A Alenazi[SUP] 13 [/SUP], Mai Alalawi[SUP] 16 [/SUP], Omar Al Zumai[SUP] 17 18 19 [/SUP], Hussain Al Haji[SUP] 20 18 19 [/SUP], Sarah T Al Dughaish[SUP] 21 [/SUP], Abdulrahman S Alawaji[SUP] 17 [/SUP], Haifa A Alhaidal[SUP] 17 20 [/SUP], Ghassan Al Ghamdi[SUP] 20 22 23 [/SUP]
Affiliations
- PMID: 37641042
- DOI: 10.1186/s12890-023-02603-4
Background: Previous studies have shown mortality benefits with corticosteroids in Coronavirus disease-19 (COVID-19). However, there is inconsistency regarding the use of methylprednisolone over dexamethasone in COVID-19, and this has not been extensively evaluated in patients with a history of asthma. This study aims to investigate and compare the effectiveness and safety of methylprednisolone and dexamethasone in critically ill patients with asthma and COVID-19.
Methods: The primary endpoint was the in-hospital mortality. Other endpoints include 30-day mortality, respiratory failure requiring mechanical ventilation (MV), acute kidney injury (AKI), acute liver injury, length of stay (LOS), ventilator-free days (VFDs), and hospital-acquired infections. Propensity score (PS) matching, and regression analyses were used.
Results: A total of one hundred-five patients were included. Thirty patients received methylprednisolone, whereas seventy-five patients received dexamethasone. After PS matching (1:1 ratio), patients who received methylprednisolone had higher but insignificant in-hospital mortality in both crude and logistic regression analysis, [(35.0% vs. 18.2%, P = 0.22) and (OR 2.31; CI: 0.56 - 9.59; P = 0.25), respectively]. There were no statistically significant differences in the 30-day mortality, respiratory failure requiring MV, AKI, acute liver injury, ICU LOS, hospital LOS, and hospital-acquired infections.
Conclusions: Methylprednisolone in COVID-19 patients with asthma may lead to increased in-hospital mortality and shorter VFDs compared to dexamethasone; however, it failed to reach statistical significance. Therefore, it is necessary to interpret these data cautiously, and further large-scale randomized clinical trials are needed to establish more conclusive evidence and support these conclusions.
Keywords: Asthma; COVID-19; Critically ill; Dexamethasone; Intensive Care Units; Length of stay (LOS); MV duration; Methylprednisolone; Mortality; SARS-CoV-2.