Dataset Information

Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study.

ABSTRACT:

Objective

To assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19).

Methods

A multicentre observational study was performed from 22 February through 30 June 2020. We included consecutive adult patients with severe COVID-19, defined as respiratory rate ?30 breath per minute, oxygen saturation ?93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ?300 mm Hg. We excluded patients being treated with other immunomodulant drugs, receiving low-dose corticosteroids and receiving corticosteroids 72 hours after admission. The primary endpoint was 30-day mortality from hospital admission. The main exposure variable was corticosteroid therapy at a dose of ?0.5 mg/kg of prednisone equivalents. It was introduced as binomial covariate in a logistic regression model for the primary endpoint and inverse probability of treatment weighting using the propensity score.

Results

Of 1717 patients with COVID-19 evaluated, 513 were included in the study, and of these, 170 (33%) were treated with corticosteroids. During hospitalization, 166 patients (34%) met the criteria of the primary outcome (60/170, 35% in the corticosteroid group and 106/343, 31% in the noncorticosteroid group). At multivariable analysis corticosteroid treatment was not associated with lower 30-day mortality rate (adjusted odds ratio, 0.59; 95% confidence interval (CI), 0.20-1.74; p 0.33). After inverse probability of treatment weighting, corticosteroids were not associated with lower 30-day mortality (average treatment effect, 0.05; 95% CI, -0.02 to 0.09; p 0.12). However, subgroup analysis revealed that in patients with PO2/FiO2 < 200 mm Hg at admission (135 patients, 52 (38%) treated with corticosteroids), corticosteroid treatment was associated with a lower risk of 30-day mortality (23/52, 44% vs. 45/83, 54%; adjusted odds ratio, 0.20; 95% CI, 0.04-0.90; p 0.036).

Conclusions

The effect of corticosteroid treatment on mortality might be limited to critically ill COVID-19 patients.

SUBMITTER: Bartoletti M

PROVIDER: S-EPMC7506332 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study.

Bartoletti Michele M Marconi Lorenzo L Scudeller Luigia L Pancaldi Livia L Tedeschi Sara S Giannella Maddalena M Rinaldi Matteo M Bussini Linda L Valentini Ilaria I Ferravante Anna Filomena AF Potalivo Antonella A Marchionni Elisa E Fornaro Giacomo G Pascale Renato R Pasquini Zeno Z Puoti Massimo M Merli Marco M Barchiesi Francesco F Volpato Francesca F Rubin Arianna A Saracino Annalisa A Tonetti Tommaso T Gaibani Paolo P Ranieri Vito Marco VM Viale Pierluigi P Cristini Francesco F

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 20200922 1

<h4>Objective</h4>To assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19).<h4>Methods</h4>A multicentre observational study was performed from 22 February through 30 June 2020. We included consecutive adult patients with severe COVID-19, defined as respiratory rate ≥30 breath per minute, oxygen saturation ≤93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ≤300 mm Hg. We excluded patients being treated with other immuno ...[more]

PMID: 32971254

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Project description:BackgroundSome unanswered questions persist regarding the effectiveness of corticosteroids for severe coronavirus disease 2019 (COVID-19) patients. We aimed to assess the clinical effect of corticosteroids on intensive care unit (ICU) mortality among mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients.MethodsThis was a retrospective study of prospectively collected data conducted in 70 ICUs (68 Spanish, one Andorran, one Irish), including mechanically ventilated COVID-19-associated ARDS patients admitted between February 6 and September 20, 2020. Individuals who received corticosteroids for refractory shock were excluded. Patients exposed to corticosteroids at admission were matched with patients without corticosteroids through propensity score matching. Primary outcome was all-cause ICU mortality. Secondary outcomes were to compare in-hospital mortality, ventilator-free days at 28 days, respiratory superinfection and length of stay between patients with corticosteroids and those without corticosteroids. We performed survival analysis accounting for competing risks and subgroup sensitivity analysis.ResultsWe included 1835 mechanically ventilated COVID-19-associated ARDS, of whom 1117 (60.9%) received corticosteroids. After propensity score matching, ICU mortality did not differ between patients treated with corticosteroids and untreated patients (33.8% vs. 30.9%; p = 0.28). In survival analysis, corticosteroid treatment at ICU admission was associated with short-term survival benefit (HR 0.53; 95% CI 0.39-0.72), although beyond the 17th day of admission, this effect switched and there was an increased ICU mortality (long-term HR 1.68; 95% CI 1.16-2.45). The sensitivity analysis reinforced the results. Subgroups of age < 60 years, severe ARDS and corticosteroids plus tocilizumab could have greatest benefit from corticosteroids as short-term decreased ICU mortality without long-term negative effects were observed. Larger length of stay was observed with corticosteroids among non-survivors both in the ICU and in hospital. There were no significant differences for the remaining secondary outcomes.ConclusionsOur results suggest that corticosteroid treatment for mechanically ventilated COVID-19-associated ARDS had a biphasic time-dependent effect on ICU mortality. Specific subgroups showed clear effect on improving survival with corticosteroid use. Therefore, further research is required to identify treatment-responsive subgroups among the mechanically ventilated COVID-19-associated ARDS patients.

Dataset Information

Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study.

Objective

Methods

Results

Conclusions

Publications

Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study.

Similar Datasets

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