tetano
Editor, Senior Moderator
Int J Infect Dis
. 2021 May 27;S1201-9712(21)00458-6.
doi: 10.1016/j.ijid.2021.05.056. Online ahead of print.
Determinants of the protective effect of glucocorticoids on mortality in hospitalized patients with COVID-19: Insights from the Cardio-COVID-Italy multicenter study
Matteo Pagnesi[SUP] 1 [/SUP], Riccardo M Inciardi[SUP] 1 [/SUP], Carlo Mario Lombardi[SUP] 1 [/SUP], Piergiuseppe Agostoni[SUP] 2 [/SUP], Pietro Ameri[SUP] 3 [/SUP], Lucia Barbieri[SUP] 4 [/SUP], Antonio Bellasi[SUP] 5 [/SUP], Rita Camporotondo[SUP] 6 [/SUP], Claudia Canale[SUP] 3 [/SUP], Valentina Carubelli[SUP] 1 [/SUP], Stefano Carugo[SUP] 7 [/SUP], Francesco Catagnano[SUP] 8 [/SUP], Laura A Dalla Vecchia[SUP] 9 [/SUP], Gian Battista Danzi[SUP] 10 [/SUP], Mattia Di Pasquale[SUP] 1 [/SUP], Margherita Gaudenzi[SUP] 2 [/SUP], Stefano Giovinazzo[SUP] 3 [/SUP], Massimiliano Gnecchi[SUP] 6 [/SUP], Marco Guazzi[SUP] 11 [/SUP], Annamaria Iorio[SUP] 12 [/SUP], Maria Teresa La Rovere[SUP] 13 [/SUP], Sergio Leonardi[SUP] 6 [/SUP], Gloria Maccagni[SUP] 10 [/SUP], Massimo Mapelli[SUP] 2 [/SUP], Davide Margonato[SUP] 8 [/SUP], Marco Merlo[SUP] 14 [/SUP], Luca Monzo[SUP] 15 [/SUP], Andrea Mortara[SUP] 16 [/SUP], Vincenzo Nuzzi[SUP] 14 [/SUP], Massimo Piepoli[SUP] 17 [/SUP], Italo Porto[SUP] 3 [/SUP], Andrea Pozzi[SUP] 12 [/SUP], Filippo Sarullo[SUP] 18 [/SUP], Gianfranco Sinagra[SUP] 14 [/SUP], Chiara Tedino[SUP] 1 [/SUP], Daniela Tomasoni[SUP] 1 [/SUP], Maurizio Volterrani[SUP] 19 [/SUP], Gregorio Zaccone[SUP] 1 [/SUP], Michele Senni[SUP] 12 [/SUP], Marco Metra[SUP] 20 [/SUP]
Affiliations
Abstract
Background: Glucocorticoid therapy has emerged as an effective therapeutic option in hospitalized patients with coronavirus disease 2019 (COVID-19). Our aim was to focus on the impact of relevant clinical and laboratory factors on the protective effect of glucocorticoids on mortality.
Methods: We performed a sub-analysis of the multicenter Cardio-COVID-Italy registry, enrolling consecutive patients with COVID-19 admitted to 13 Italian cardiology units between March 1[SUP]st[/SUP], 2020, and April 9[SUP]th[/SUP], 2020. The primary endpoint was in-hospital mortality.
Results: A total of 706 COVID-19 patients were included (n = 349 treated with glucocorticoids, n = 357 not treated with glucocorticoids). After adjustment for relevant covariates, use of glucocorticoids was associated with a lower risk of in-hospital mortality (adjusted HR 0.44, 95% CI 0.26-0.72, p = 0.001). A significant interaction was observed between the protective effect of glucocorticoids on mortality and PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio on admission (p = 0.042), oxygen saturation on admission (p = 0.017), and peak CRP (0.023). Such protective effect of glucocorticoids was mainly observed in patients with lower PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio (<300), lower oxygen saturation (<90%), and higher CRP (>100 mg/L).
Conclusions: The protective effects of glucocorticoids on mortality in COVID-19 was more evident among patients of worse respiratory parameters and higher systemic inflammation.
Keywords: COVID-19; SARS-CoV-2; corticosteroid; glucocorticoid; steroid.
. 2021 May 27;S1201-9712(21)00458-6.
doi: 10.1016/j.ijid.2021.05.056. Online ahead of print.
Determinants of the protective effect of glucocorticoids on mortality in hospitalized patients with COVID-19: Insights from the Cardio-COVID-Italy multicenter study
Matteo Pagnesi[SUP] 1 [/SUP], Riccardo M Inciardi[SUP] 1 [/SUP], Carlo Mario Lombardi[SUP] 1 [/SUP], Piergiuseppe Agostoni[SUP] 2 [/SUP], Pietro Ameri[SUP] 3 [/SUP], Lucia Barbieri[SUP] 4 [/SUP], Antonio Bellasi[SUP] 5 [/SUP], Rita Camporotondo[SUP] 6 [/SUP], Claudia Canale[SUP] 3 [/SUP], Valentina Carubelli[SUP] 1 [/SUP], Stefano Carugo[SUP] 7 [/SUP], Francesco Catagnano[SUP] 8 [/SUP], Laura A Dalla Vecchia[SUP] 9 [/SUP], Gian Battista Danzi[SUP] 10 [/SUP], Mattia Di Pasquale[SUP] 1 [/SUP], Margherita Gaudenzi[SUP] 2 [/SUP], Stefano Giovinazzo[SUP] 3 [/SUP], Massimiliano Gnecchi[SUP] 6 [/SUP], Marco Guazzi[SUP] 11 [/SUP], Annamaria Iorio[SUP] 12 [/SUP], Maria Teresa La Rovere[SUP] 13 [/SUP], Sergio Leonardi[SUP] 6 [/SUP], Gloria Maccagni[SUP] 10 [/SUP], Massimo Mapelli[SUP] 2 [/SUP], Davide Margonato[SUP] 8 [/SUP], Marco Merlo[SUP] 14 [/SUP], Luca Monzo[SUP] 15 [/SUP], Andrea Mortara[SUP] 16 [/SUP], Vincenzo Nuzzi[SUP] 14 [/SUP], Massimo Piepoli[SUP] 17 [/SUP], Italo Porto[SUP] 3 [/SUP], Andrea Pozzi[SUP] 12 [/SUP], Filippo Sarullo[SUP] 18 [/SUP], Gianfranco Sinagra[SUP] 14 [/SUP], Chiara Tedino[SUP] 1 [/SUP], Daniela Tomasoni[SUP] 1 [/SUP], Maurizio Volterrani[SUP] 19 [/SUP], Gregorio Zaccone[SUP] 1 [/SUP], Michele Senni[SUP] 12 [/SUP], Marco Metra[SUP] 20 [/SUP]
Affiliations
- PMID: 34052406
- PMCID: PMC8159705
- DOI: 10.1016/j.ijid.2021.05.056
Abstract
Background: Glucocorticoid therapy has emerged as an effective therapeutic option in hospitalized patients with coronavirus disease 2019 (COVID-19). Our aim was to focus on the impact of relevant clinical and laboratory factors on the protective effect of glucocorticoids on mortality.
Methods: We performed a sub-analysis of the multicenter Cardio-COVID-Italy registry, enrolling consecutive patients with COVID-19 admitted to 13 Italian cardiology units between March 1[SUP]st[/SUP], 2020, and April 9[SUP]th[/SUP], 2020. The primary endpoint was in-hospital mortality.
Results: A total of 706 COVID-19 patients were included (n = 349 treated with glucocorticoids, n = 357 not treated with glucocorticoids). After adjustment for relevant covariates, use of glucocorticoids was associated with a lower risk of in-hospital mortality (adjusted HR 0.44, 95% CI 0.26-0.72, p = 0.001). A significant interaction was observed between the protective effect of glucocorticoids on mortality and PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio on admission (p = 0.042), oxygen saturation on admission (p = 0.017), and peak CRP (0.023). Such protective effect of glucocorticoids was mainly observed in patients with lower PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio (<300), lower oxygen saturation (<90%), and higher CRP (>100 mg/L).
Conclusions: The protective effects of glucocorticoids on mortality in COVID-19 was more evident among patients of worse respiratory parameters and higher systemic inflammation.
Keywords: COVID-19; SARS-CoV-2; corticosteroid; glucocorticoid; steroid.