tetano
Editor, Senior Moderator
Eur J Clin Invest
. 2020 Nov 20;e13458.
doi: 10.1111/eci.13458. Online ahead of print.
High-Dose Methylprednisolone in Nonintubated Patients with Severe COVID-19 Pneumonia
Aikaterini Papamanoli[SUP] 1 [/SUP], Jeanwoo Yoo[SUP] 2 [/SUP], Prabhjot Grewal[SUP] 2 [/SUP], William Predun[SUP] 2 [/SUP], Jessica Hotelling[SUP] 2 [/SUP], Robin Jacob[SUP] 2 [/SUP], Azad Mojahedi[SUP] 2 [/SUP], Hal A Skopicki[SUP] 3 [/SUP], Mohamed Mansour[SUP] 4 [/SUP], Luis A Marcos[SUP] 1 [/SUP], Andreas P Kalogeropoulos[SUP] 3 [/SUP]
Affiliations
Abstract
Background: Recent trials with dexamethasone and hydrocortisone have demonstrated benefit in patients with coronavirus disease 2019 (COVID-19). Data on methylprednisolone are limited.
Methods: Retrospective cohort of consecutive adults with severe COVID-19 pneumonia on high-flow oxygen (FiO[SUB]2[/SUB] ≥50%) admitted to an academic center in New York, from March 1 to April 15, 2020. We used inverse probability of treatment weights to estimate the effect of methylprednisolone on clinical outcomes and intensive care resources utilization.
Results: Of 447 patients, 153 (34.2%) received methylprednisolone and 294 (65.8%) received no corticosteroids. At 28 days, 102 patients (22.8%) had died and 115 (25.7%) received mechanical ventilation. In weighted analyses, risk for death or mechanical ventilation was 37% lower with methylprednisolone (hazard ratio 0.63; 95%CI 0.47-0.86; P=0.003), driven by less frequent mechanical ventilation (subhazard ratio 0.56; 95%CI 0.40-0.79; P=0.001); mortality did not differ between groups. The methylprednisolone group had 2.8 more ventilator-free days (95%CI 0.5-5.1; P=0.017) and 2.6 more intensive care-free days (95%CI 0.2-4.9; P=0.033) during the first 28 days. Complications rates were not higher with methylprednisolone.
Conclusions: In nonintubated patients with severe COVID-19 pneumonia, methylprednisolone was associated with reduced need for mechanical ventilation and less intensive care resources utilization without excess complications.
Keywords: COVID-19; health care resources utilization; intensive care unit; mechanical ventilation; methylprednisolone; pneumonia.
. 2020 Nov 20;e13458.
doi: 10.1111/eci.13458. Online ahead of print.
High-Dose Methylprednisolone in Nonintubated Patients with Severe COVID-19 Pneumonia
Aikaterini Papamanoli[SUP] 1 [/SUP], Jeanwoo Yoo[SUP] 2 [/SUP], Prabhjot Grewal[SUP] 2 [/SUP], William Predun[SUP] 2 [/SUP], Jessica Hotelling[SUP] 2 [/SUP], Robin Jacob[SUP] 2 [/SUP], Azad Mojahedi[SUP] 2 [/SUP], Hal A Skopicki[SUP] 3 [/SUP], Mohamed Mansour[SUP] 4 [/SUP], Luis A Marcos[SUP] 1 [/SUP], Andreas P Kalogeropoulos[SUP] 3 [/SUP]
Affiliations
- PMID: 33219551
- DOI: 10.1111/eci.13458
Abstract
Background: Recent trials with dexamethasone and hydrocortisone have demonstrated benefit in patients with coronavirus disease 2019 (COVID-19). Data on methylprednisolone are limited.
Methods: Retrospective cohort of consecutive adults with severe COVID-19 pneumonia on high-flow oxygen (FiO[SUB]2[/SUB] ≥50%) admitted to an academic center in New York, from March 1 to April 15, 2020. We used inverse probability of treatment weights to estimate the effect of methylprednisolone on clinical outcomes and intensive care resources utilization.
Results: Of 447 patients, 153 (34.2%) received methylprednisolone and 294 (65.8%) received no corticosteroids. At 28 days, 102 patients (22.8%) had died and 115 (25.7%) received mechanical ventilation. In weighted analyses, risk for death or mechanical ventilation was 37% lower with methylprednisolone (hazard ratio 0.63; 95%CI 0.47-0.86; P=0.003), driven by less frequent mechanical ventilation (subhazard ratio 0.56; 95%CI 0.40-0.79; P=0.001); mortality did not differ between groups. The methylprednisolone group had 2.8 more ventilator-free days (95%CI 0.5-5.1; P=0.017) and 2.6 more intensive care-free days (95%CI 0.2-4.9; P=0.033) during the first 28 days. Complications rates were not higher with methylprednisolone.
Conclusions: In nonintubated patients with severe COVID-19 pneumonia, methylprednisolone was associated with reduced need for mechanical ventilation and less intensive care resources utilization without excess complications.
Keywords: COVID-19; health care resources utilization; intensive care unit; mechanical ventilation; methylprednisolone; pneumonia.