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Early Experience With Methylprednisolone on SARS-CoV-2 Infection in the African American Population, a Retrospective Analysis
BACKGROUND: Coronavirus disease-19 (COVID-19) is associated with acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS) with high mortality rates. In African American (AA) populations, COVID-19 presentations and outcomes are more severe. NIH and Interim WHO guidelines had suggested...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745550/ https://www.ncbi.nlm.nih.gov/pubmed/33402859 http://dx.doi.org/10.1177/1179548420980699 |
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author | Saggi, Subodh J Nath, Sridesh Culas, Roshni Chittalae, Seema Burza, Aaliya Srinivasan, Maya Abdul, Rishard Silver, Benjamin Lora, Alnardo Ibtida, Ishmam Chokshi, Tanuj Capric, Violeta Mohamed, Ammar Worah, Samrat OuYang, Jie Geraghty, Patrick Gruessner, Angelika Salifu, Moro O |
author_facet | Saggi, Subodh J Nath, Sridesh Culas, Roshni Chittalae, Seema Burza, Aaliya Srinivasan, Maya Abdul, Rishard Silver, Benjamin Lora, Alnardo Ibtida, Ishmam Chokshi, Tanuj Capric, Violeta Mohamed, Ammar Worah, Samrat OuYang, Jie Geraghty, Patrick Gruessner, Angelika Salifu, Moro O |
author_sort | Saggi, Subodh J |
collection | PubMed |
description | BACKGROUND: Coronavirus disease-19 (COVID-19) is associated with acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS) with high mortality rates. In African American (AA) populations, COVID-19 presentations and outcomes are more severe. NIH and Interim WHO guidelines had suggested against the use of corticosteroids unless in clinical trials until the recent publication of the RECOVERY trial. Here, we analyzed the treatment effect of methylprednisolone on patients with AKI and ARDS during the initial 2 months of COVID-19 and detail the learning effect within our institution. METHODS: Between March 1 and April 30, 2020, 75 AA patients met our inclusion criteria for ARDS and AKI, of which 37 had received corticosteroids. Twenty-eight-day mortality, improvement in PaO(2)/FiO(2) ratio, and renal function were analyzed. The impact of methylprednisolone treatment was assessed with multivariable methods. RESULTS: Survival in the methylprednisolone group reached 51% at 21 days compared to 29% in the non-corticosteroid group (P < .001). Methylprednisolone improved the likelihood of renal function improvement. PaO(2)/FiO(2) ratio in the methylprednisolone group improved by 73% compared to 45% in the non-corticosteroid group (P = .01). Age, gender, BMI, preexisting conditions, and other treatment factors did not show any impact on renal or PaO(2)/FiO(2) ratio improvement. The use of anticoagulants, the month of treatment, and AKI during hospitalization also influenced outcomes. CONCLUSION: In AA COVID-19 positive patients with ARDS and AKI, IV methylprednisolone lowered the incidence of mortality and improved the likelihood of renal and lung function recovery. Further investigation with a randomized control trial of corticosteroids is warranted. |
format | Online Article Text |
id | pubmed-7745550 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-77455502021-01-04 Early Experience With Methylprednisolone on SARS-CoV-2 Infection in the African American Population, a Retrospective Analysis Saggi, Subodh J Nath, Sridesh Culas, Roshni Chittalae, Seema Burza, Aaliya Srinivasan, Maya Abdul, Rishard Silver, Benjamin Lora, Alnardo Ibtida, Ishmam Chokshi, Tanuj Capric, Violeta Mohamed, Ammar Worah, Samrat OuYang, Jie Geraghty, Patrick Gruessner, Angelika Salifu, Moro O Clin Med Insights Circ Respir Pulm Med Original Research BACKGROUND: Coronavirus disease-19 (COVID-19) is associated with acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS) with high mortality rates. In African American (AA) populations, COVID-19 presentations and outcomes are more severe. NIH and Interim WHO guidelines had suggested against the use of corticosteroids unless in clinical trials until the recent publication of the RECOVERY trial. Here, we analyzed the treatment effect of methylprednisolone on patients with AKI and ARDS during the initial 2 months of COVID-19 and detail the learning effect within our institution. METHODS: Between March 1 and April 30, 2020, 75 AA patients met our inclusion criteria for ARDS and AKI, of which 37 had received corticosteroids. Twenty-eight-day mortality, improvement in PaO(2)/FiO(2) ratio, and renal function were analyzed. The impact of methylprednisolone treatment was assessed with multivariable methods. RESULTS: Survival in the methylprednisolone group reached 51% at 21 days compared to 29% in the non-corticosteroid group (P < .001). Methylprednisolone improved the likelihood of renal function improvement. PaO(2)/FiO(2) ratio in the methylprednisolone group improved by 73% compared to 45% in the non-corticosteroid group (P = .01). Age, gender, BMI, preexisting conditions, and other treatment factors did not show any impact on renal or PaO(2)/FiO(2) ratio improvement. The use of anticoagulants, the month of treatment, and AKI during hospitalization also influenced outcomes. CONCLUSION: In AA COVID-19 positive patients with ARDS and AKI, IV methylprednisolone lowered the incidence of mortality and improved the likelihood of renal and lung function recovery. Further investigation with a randomized control trial of corticosteroids is warranted. SAGE Publications 2020-12-14 /pmc/articles/PMC7745550/ /pubmed/33402859 http://dx.doi.org/10.1177/1179548420980699 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Saggi, Subodh J Nath, Sridesh Culas, Roshni Chittalae, Seema Burza, Aaliya Srinivasan, Maya Abdul, Rishard Silver, Benjamin Lora, Alnardo Ibtida, Ishmam Chokshi, Tanuj Capric, Violeta Mohamed, Ammar Worah, Samrat OuYang, Jie Geraghty, Patrick Gruessner, Angelika Salifu, Moro O Early Experience With Methylprednisolone on SARS-CoV-2 Infection in the African American Population, a Retrospective Analysis |
title | Early Experience With Methylprednisolone on SARS-CoV-2 Infection in the African American Population, a Retrospective Analysis |
title_full | Early Experience With Methylprednisolone on SARS-CoV-2 Infection in the African American Population, a Retrospective Analysis |
title_fullStr | Early Experience With Methylprednisolone on SARS-CoV-2 Infection in the African American Population, a Retrospective Analysis |
title_full_unstemmed | Early Experience With Methylprednisolone on SARS-CoV-2 Infection in the African American Population, a Retrospective Analysis |
title_short | Early Experience With Methylprednisolone on SARS-CoV-2 Infection in the African American Population, a Retrospective Analysis |
title_sort | early experience with methylprednisolone on sars-cov-2 infection in the african american population, a retrospective analysis |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745550/ https://www.ncbi.nlm.nih.gov/pubmed/33402859 http://dx.doi.org/10.1177/1179548420980699 |
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