tetano
Editor, Senior Moderator
Crit Care
. 2020 Nov 10;24(1):643.
doi: 10.1186/s13054-020-03340-4.
Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis
Chaomin Wu[SUP] 1 2 [/SUP], Dongni Hou[SUP] 2 [/SUP], Chunling Du[SUP] 1 [/SUP], Yanping Cai[SUP] 3 [/SUP], Junhua Zheng[SUP] 4 [/SUP], Jie Xu[SUP] 5 [/SUP], Xiaoyan Chen[SUP] 2 [/SUP], Cuicui Chen[SUP] 2 [/SUP], Xianglin Hu[SUP] 2 [/SUP], Yuye Zhang[SUP] 2 [/SUP], Juan Song[SUP] 2 [/SUP], Lu Wang[SUP] 2 [/SUP], Yen-Cheng Chao[SUP] 2 [/SUP], Yun Feng[SUP] 6 [/SUP], Weining Xiong[SUP] 7 [/SUP], Dechang Chen[SUP] 8 [/SUP], Ming Zhong[SUP] 9 [/SUP], Jie Hu[SUP] 2 [/SUP], Jinjun Jiang[SUP] 2 [/SUP], Chunxue Bai[SUP] 2 [/SUP], Xin Zhou[SUP] 10 [/SUP], Jinfu Xu[SUP] 11 [/SUP], Yuanlin Song[SUP] 12 13 14 15 16 [/SUP], Fengyun Gong[SUP] 17 [/SUP]
Affiliations
Abstract
Background: The impact of corticosteroid therapy on outcomes of patients with coronavirus disease 2019 (COVID-19) is highly controversial. We aimed to compare the risk of death between COVID-19-related ARDS patients with corticosteroid treatment and those without.
Methods: In this single-center retrospective observational study, patients with ARDS caused by COVID-19 between January 20, 2020, and February 24, 2020, were enrolled. The primary outcome was 60-day in-hospital death. The exposure was prescribed systemic corticosteroids or not. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for 60-day in-hospital mortality.
Results: A total of 382 patients [60.7 ? 14.1 years old (mean ? SD), 61.3% males] were analyzed. The median of sequential organ failure assessment (SOFA) score was 2.0 (IQR 2.0-3.0). Of these cases, 94 (24.6%) patients had invasive mechanical ventilation. The number of patients received systemic corticosteroids was 226 (59.2%), and 156 (40.8%) received standard treatment. The maximum dose of corticosteroids was 80.0 (IQR 40.0-80.0) mg equivalent methylprednisolone per day, and duration of corticosteroid treatment was 7.0 (4.0-12.0) days in total. In Cox regression analysis using corticosteroid treatment as a time-varying variable, corticosteroid treatment was associated with a significant reduction in risk of in-hospital death within 60 days after adjusting for age, sex, SOFA score at hospital admission, propensity score of corticosteroid treatment, comorbidities, antiviral treatment, and respiratory supports (HR 0.42; 95% CI 0.21, 0.85; p = 0.0160). Corticosteroids were not associated with delayed viral RNA clearance in our cohort.
Conclusion: In this clinical practice setting, low-dose corticosteroid treatment was associated with reduced risk of in-hospital death within 60 days in COVID-19 patients who developed ARDS.
Keywords: Coronavirus disease 2019; Corticosteroids; Methylprednisolone; Mortality; Propensity score; Severe acute respiratory syndrome coronavirus 2.
. 2020 Nov 10;24(1):643.
doi: 10.1186/s13054-020-03340-4.
Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis
Chaomin Wu[SUP] 1 2 [/SUP], Dongni Hou[SUP] 2 [/SUP], Chunling Du[SUP] 1 [/SUP], Yanping Cai[SUP] 3 [/SUP], Junhua Zheng[SUP] 4 [/SUP], Jie Xu[SUP] 5 [/SUP], Xiaoyan Chen[SUP] 2 [/SUP], Cuicui Chen[SUP] 2 [/SUP], Xianglin Hu[SUP] 2 [/SUP], Yuye Zhang[SUP] 2 [/SUP], Juan Song[SUP] 2 [/SUP], Lu Wang[SUP] 2 [/SUP], Yen-Cheng Chao[SUP] 2 [/SUP], Yun Feng[SUP] 6 [/SUP], Weining Xiong[SUP] 7 [/SUP], Dechang Chen[SUP] 8 [/SUP], Ming Zhong[SUP] 9 [/SUP], Jie Hu[SUP] 2 [/SUP], Jinjun Jiang[SUP] 2 [/SUP], Chunxue Bai[SUP] 2 [/SUP], Xin Zhou[SUP] 10 [/SUP], Jinfu Xu[SUP] 11 [/SUP], Yuanlin Song[SUP] 12 13 14 15 16 [/SUP], Fengyun Gong[SUP] 17 [/SUP]
Affiliations
- PMID: 33172477
- DOI: 10.1186/s13054-020-03340-4
Abstract
Background: The impact of corticosteroid therapy on outcomes of patients with coronavirus disease 2019 (COVID-19) is highly controversial. We aimed to compare the risk of death between COVID-19-related ARDS patients with corticosteroid treatment and those without.
Methods: In this single-center retrospective observational study, patients with ARDS caused by COVID-19 between January 20, 2020, and February 24, 2020, were enrolled. The primary outcome was 60-day in-hospital death. The exposure was prescribed systemic corticosteroids or not. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for 60-day in-hospital mortality.
Results: A total of 382 patients [60.7 ? 14.1 years old (mean ? SD), 61.3% males] were analyzed. The median of sequential organ failure assessment (SOFA) score was 2.0 (IQR 2.0-3.0). Of these cases, 94 (24.6%) patients had invasive mechanical ventilation. The number of patients received systemic corticosteroids was 226 (59.2%), and 156 (40.8%) received standard treatment. The maximum dose of corticosteroids was 80.0 (IQR 40.0-80.0) mg equivalent methylprednisolone per day, and duration of corticosteroid treatment was 7.0 (4.0-12.0) days in total. In Cox regression analysis using corticosteroid treatment as a time-varying variable, corticosteroid treatment was associated with a significant reduction in risk of in-hospital death within 60 days after adjusting for age, sex, SOFA score at hospital admission, propensity score of corticosteroid treatment, comorbidities, antiviral treatment, and respiratory supports (HR 0.42; 95% CI 0.21, 0.85; p = 0.0160). Corticosteroids were not associated with delayed viral RNA clearance in our cohort.
Conclusion: In this clinical practice setting, low-dose corticosteroid treatment was associated with reduced risk of in-hospital death within 60 days in COVID-19 patients who developed ARDS.
Keywords: Coronavirus disease 2019; Corticosteroids; Methylprednisolone; Mortality; Propensity score; Severe acute respiratory syndrome coronavirus 2.