tetano
Editor, Senior Moderator
Med Clin (Engl Ed)
. 2020 Nov 27.
doi: 10.1016/j.medcle.2020.08.001. Online ahead of print.
Association between high-dose steroid therapy, respiratory function, and time to discharge in patients with COVID-19: Cohort study
Alejandro Rodr?guez-Molinero[SUP] 1 [/SUP], Carlos P?rez-L?pez[SUP] 2 [/SUP], C?sar G?lvez-Barr?n[SUP] 1 [/SUP], Antonio Mi?arro[SUP] 3 [/SUP], Ezequiel A Rodr?guez Gullello[SUP] 1 [/SUP], Isabel Collado P?rez[SUP] 1 [/SUP], N?ria Mil? R?fols[SUP] 1 [/SUP], Ernesto E M?naco[SUP] 1 [/SUP], Antonio Hidalgo Garc?a[SUP] 1 [/SUP], Gemma A?a?os Carrasco[SUP] 1 [/SUP], Antonio Chamero Pastilla[SUP] 1 [/SUP], en representaci?n del grupo de investigadores para la COVID-19 del Consorci Sanitari de l’Alt Pened?s i Garraf (CSAPG)
Collaborators, Affiliations
Abstract
in English, Spanish
Objective: To analyze whether there is an association between the use glucocorticoids at high doses, and the evolution of saturation/fraction of inspired oxygen (SAFI) or time to discharge, in patients hospitalized with COVID-19.
Methods: This was an observational study on a cohort of 418 patients admitted to three regional hospitals in Catalonia, Spain. As primary outcomes, we studied the evolution of SAFI in the first 48 h of treatment and the time to discharge. The results were compared between patients treated and untreated with glucocorticoids (methylprednisolone 1 mg/kg/day o dexamethasone 20-40 mg/day) through sub-cohort analyses matched for multiple clinical and prognostic factors, as well as through Cox multivariate models adjusted for prognostic factors. The simultaneous use of different treatments for COVID-19 was taken into account, both in sub-cohorts matching and in COX regression.
Results: There were 187 patients treated with glucocorticoids; of these, 25 patients could be matched with an equivalent number of control patients. In the analysis of these matched sub-cohorts, no significant difference was observed in time to discharge (log-rank: p = 0.291) or the increment in SAFI at 48 hours of treatment (glucocorticoides: -0.04; controls: +0.37; p = 0.095). Multivariate models using Cox regression showed a significantly longer time to discharge in patients treated with glucocorticoids (hazard ratio: 7.26; 95% IC: 3.30-15.95).
Conclusions: We have not found improvement in respiratory function or time until discharge, associated with the use of glucocorticoids at high doses.
Keywords: COVID-19; Coronavirus; Dexamethasone; Glucocorticoids; Methylprednisolone; SARS-CoV-2.
. 2020 Nov 27.
doi: 10.1016/j.medcle.2020.08.001. Online ahead of print.
Association between high-dose steroid therapy, respiratory function, and time to discharge in patients with COVID-19: Cohort study
Alejandro Rodr?guez-Molinero[SUP] 1 [/SUP], Carlos P?rez-L?pez[SUP] 2 [/SUP], C?sar G?lvez-Barr?n[SUP] 1 [/SUP], Antonio Mi?arro[SUP] 3 [/SUP], Ezequiel A Rodr?guez Gullello[SUP] 1 [/SUP], Isabel Collado P?rez[SUP] 1 [/SUP], N?ria Mil? R?fols[SUP] 1 [/SUP], Ernesto E M?naco[SUP] 1 [/SUP], Antonio Hidalgo Garc?a[SUP] 1 [/SUP], Gemma A?a?os Carrasco[SUP] 1 [/SUP], Antonio Chamero Pastilla[SUP] 1 [/SUP], en representaci?n del grupo de investigadores para la COVID-19 del Consorci Sanitari de l’Alt Pened?s i Garraf (CSAPG)
Collaborators, Affiliations
- PMID: 33263084
- PMCID: PMC7691846
- DOI: 10.1016/j.medcle.2020.08.001
Abstract
in English, Spanish
Objective: To analyze whether there is an association between the use glucocorticoids at high doses, and the evolution of saturation/fraction of inspired oxygen (SAFI) or time to discharge, in patients hospitalized with COVID-19.
Methods: This was an observational study on a cohort of 418 patients admitted to three regional hospitals in Catalonia, Spain. As primary outcomes, we studied the evolution of SAFI in the first 48 h of treatment and the time to discharge. The results were compared between patients treated and untreated with glucocorticoids (methylprednisolone 1 mg/kg/day o dexamethasone 20-40 mg/day) through sub-cohort analyses matched for multiple clinical and prognostic factors, as well as through Cox multivariate models adjusted for prognostic factors. The simultaneous use of different treatments for COVID-19 was taken into account, both in sub-cohorts matching and in COX regression.
Results: There were 187 patients treated with glucocorticoids; of these, 25 patients could be matched with an equivalent number of control patients. In the analysis of these matched sub-cohorts, no significant difference was observed in time to discharge (log-rank: p = 0.291) or the increment in SAFI at 48 hours of treatment (glucocorticoides: -0.04; controls: +0.37; p = 0.095). Multivariate models using Cox regression showed a significantly longer time to discharge in patients treated with glucocorticoids (hazard ratio: 7.26; 95% IC: 3.30-15.95).
Conclusions: We have not found improvement in respiratory function or time until discharge, associated with the use of glucocorticoids at high doses.
Keywords: COVID-19; Coronavirus; Dexamethasone; Glucocorticoids; Methylprednisolone; SARS-CoV-2.