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Corticosteroids in patients hospitalized for COVID-19 pneumonia who require oxygen: observational comparative study using routine care data

OBJECTIVE: To assess the effectiveness of corticosteroids on outcomes of patients with coronavirus disease 2019 (COVID-19) pneumonia requiring oxygen without mechanical ventilation. METHODS: We used routine care data from 51 hospitals in France and Luxembourg to assess the effectiveness of corticost...

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Autores principales: Tran, Viet-Thi, Mahévas, Matthieu, Bani-Sadr, Firouze, Robineau, Olivier, Perpoint, Thomas, Perrodeau, Elodie, Gallay, Laure, Ravaud, Philippe, Goehringer, François, Lescure, François-Xavier
Formato: Online Artículo Texto
Lenguaje:English
Publicado: European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722522/
https://www.ncbi.nlm.nih.gov/pubmed/33301928
http://dx.doi.org/10.1016/j.cmi.2020.11.035
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author Tran, Viet-Thi
Mahévas, Matthieu
Bani-Sadr, Firouze
Robineau, Olivier
Perpoint, Thomas
Perrodeau, Elodie
Gallay, Laure
Ravaud, Philippe
Goehringer, François
Lescure, François-Xavier
author_facet Tran, Viet-Thi
Mahévas, Matthieu
Bani-Sadr, Firouze
Robineau, Olivier
Perpoint, Thomas
Perrodeau, Elodie
Gallay, Laure
Ravaud, Philippe
Goehringer, François
Lescure, François-Xavier
author_sort Tran, Viet-Thi
collection PubMed
description OBJECTIVE: To assess the effectiveness of corticosteroids on outcomes of patients with coronavirus disease 2019 (COVID-19) pneumonia requiring oxygen without mechanical ventilation. METHODS: We used routine care data from 51 hospitals in France and Luxembourg to assess the effectiveness of corticosteroids at 0.8 mg/kg/day eq. prednisone (CTC group) versus standard of care (no-CTC group) among adults 18–80 years old with confirmed COVID-19 pneumonia requiring oxygen without mechanical ventilation. The primary outcome was intubation or death by day 28. In our main analysis, characteristics of patients at baseline (i.e. time when patients met all inclusion criteria) were balanced by using propensity-score inverse probability of treatment weighting. RESULTS: Among the 891 patients included in the analysis, 203 were assigned to the CTC group. Use of corticosteroids was not significantly associated with risk of intubation or death by day 28 (weighted hazard ratio (wHR) 0.92, 95%CI 0.61–1.39) nor cumulative death rate (wHR 1.03, 95%CI 0.54–1.98). However, use of corticosteroids was associated with reduced risk of intubation or death by day 28 in the prespecified subgroups of patients requiring oxygen ≥3 L/min (wHR 0.50, 95%CI 0.30–0.85) or C-reactive protein level ≥100 mg/L (wHR 0.44, 95%CI 0.23–0.85). The number of hyperglycaemia events was higher for patients with corticosteroids than for those without, but the number of infections was similar. CONCLUSIONS: We found no association between the use of corticosteroids and intubation or death in the broad population of patients 18–80 years old, with COVID-19, hospitalized in settings non intensive care units. However, the treatment was associated with a reduced risk of intubation or death for patients with ≥3 L/min oxygen or C-reactive protein level ≥100 mg/L at baseline. Further research is needed to confirm the right timing for corticosteroids in patients with COVID-19 requiring oxygen only.
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spelling pubmed-77225222020-12-10 Corticosteroids in patients hospitalized for COVID-19 pneumonia who require oxygen: observational comparative study using routine care data Tran, Viet-Thi Mahévas, Matthieu Bani-Sadr, Firouze Robineau, Olivier Perpoint, Thomas Perrodeau, Elodie Gallay, Laure Ravaud, Philippe Goehringer, François Lescure, François-Xavier Clin Microbiol Infect Original Article OBJECTIVE: To assess the effectiveness of corticosteroids on outcomes of patients with coronavirus disease 2019 (COVID-19) pneumonia requiring oxygen without mechanical ventilation. METHODS: We used routine care data from 51 hospitals in France and Luxembourg to assess the effectiveness of corticosteroids at 0.8 mg/kg/day eq. prednisone (CTC group) versus standard of care (no-CTC group) among adults 18–80 years old with confirmed COVID-19 pneumonia requiring oxygen without mechanical ventilation. The primary outcome was intubation or death by day 28. In our main analysis, characteristics of patients at baseline (i.e. time when patients met all inclusion criteria) were balanced by using propensity-score inverse probability of treatment weighting. RESULTS: Among the 891 patients included in the analysis, 203 were assigned to the CTC group. Use of corticosteroids was not significantly associated with risk of intubation or death by day 28 (weighted hazard ratio (wHR) 0.92, 95%CI 0.61–1.39) nor cumulative death rate (wHR 1.03, 95%CI 0.54–1.98). However, use of corticosteroids was associated with reduced risk of intubation or death by day 28 in the prespecified subgroups of patients requiring oxygen ≥3 L/min (wHR 0.50, 95%CI 0.30–0.85) or C-reactive protein level ≥100 mg/L (wHR 0.44, 95%CI 0.23–0.85). The number of hyperglycaemia events was higher for patients with corticosteroids than for those without, but the number of infections was similar. CONCLUSIONS: We found no association between the use of corticosteroids and intubation or death in the broad population of patients 18–80 years old, with COVID-19, hospitalized in settings non intensive care units. However, the treatment was associated with a reduced risk of intubation or death for patients with ≥3 L/min oxygen or C-reactive protein level ≥100 mg/L at baseline. Further research is needed to confirm the right timing for corticosteroids in patients with COVID-19 requiring oxygen only. European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. 2021-04 2020-12-08 /pmc/articles/PMC7722522/ /pubmed/33301928 http://dx.doi.org/10.1016/j.cmi.2020.11.035 Text en © 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Original Article
Tran, Viet-Thi
Mahévas, Matthieu
Bani-Sadr, Firouze
Robineau, Olivier
Perpoint, Thomas
Perrodeau, Elodie
Gallay, Laure
Ravaud, Philippe
Goehringer, François
Lescure, François-Xavier
Corticosteroids in patients hospitalized for COVID-19 pneumonia who require oxygen: observational comparative study using routine care data
title Corticosteroids in patients hospitalized for COVID-19 pneumonia who require oxygen: observational comparative study using routine care data
title_full Corticosteroids in patients hospitalized for COVID-19 pneumonia who require oxygen: observational comparative study using routine care data
title_fullStr Corticosteroids in patients hospitalized for COVID-19 pneumonia who require oxygen: observational comparative study using routine care data
title_full_unstemmed Corticosteroids in patients hospitalized for COVID-19 pneumonia who require oxygen: observational comparative study using routine care data
title_short Corticosteroids in patients hospitalized for COVID-19 pneumonia who require oxygen: observational comparative study using routine care data
title_sort corticosteroids in patients hospitalized for covid-19 pneumonia who require oxygen: observational comparative study using routine care data
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722522/
https://www.ncbi.nlm.nih.gov/pubmed/33301928
http://dx.doi.org/10.1016/j.cmi.2020.11.035
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