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Impact of corticosteroids in hospitalised COVID-19 patients
BACKGROUND: Corticosteroids are a potential therapeutic agent for patients with COVID-19 pneumonia. The RECOVERY (Randomised Trials in COVID-19 Therapy) trial provided data on the mortality benefits of corticosteroids. The study aimed to determine the association between corticosteroid use on mortal...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023732/ https://www.ncbi.nlm.nih.gov/pubmed/33811098 http://dx.doi.org/10.1136/bmjresp-2020-000766 |
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author | Ho, Kam Sing Narasimhan, Bharat Difabrizio, Larry Rogers, Linda Bose, Sonali Li, Li Chen, Roger Sheehan, Jacqueline El-Halabi, Maan Ajwad Sarosky, Kimberly Wang, Zichen Eisenberg, Elliot Powell, Charles Steiger, David |
author_facet | Ho, Kam Sing Narasimhan, Bharat Difabrizio, Larry Rogers, Linda Bose, Sonali Li, Li Chen, Roger Sheehan, Jacqueline El-Halabi, Maan Ajwad Sarosky, Kimberly Wang, Zichen Eisenberg, Elliot Powell, Charles Steiger, David |
author_sort | Ho, Kam Sing |
collection | PubMed |
description | BACKGROUND: Corticosteroids are a potential therapeutic agent for patients with COVID-19 pneumonia. The RECOVERY (Randomised Trials in COVID-19 Therapy) trial provided data on the mortality benefits of corticosteroids. The study aimed to determine the association between corticosteroid use on mortality and infection rates and to define subgroups who may benefit from corticosteroids in a real-world setting. METHODS: Clinical data were extracted that included demographic, laboratory data and details of the therapy, including the administration of corticosteroids, azithromycin, hydroxychloroquine, tocilizumab and anticoagulation. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) admission and invasive mechanical ventilation. Outcomes were compared in patients who did and did not receive corticosteroids using the multivariate Cox regression model. RESULTS: 4313 patients were hospitalised with COVID-19 during the study period, of whom 1270 died (29.4%). When administered within the first 7 days after admission, corticosteroids were associated with reduced mortality (OR 0.73, 95% CI 0.55 to 0.97, p=0.03) and decreased transfers to the ICU (OR 0.72, 95% CI 0.47 to 1.11, p=0.02). This mortality benefit was particularly impressive in younger patients (<65 years of age), females and those with elevated inflammatory markers, defined as C reactive protein ≥150 mg/L (p≤0.05), interleukin-6 ≥20 pg/mL (p≤0.05) or D-dimer ≥2.0 µg/L (p≤0.05). Therapy was safe with similar rates of bacteraemia and fungaemia in corticosteroid-treated and non-corticosteroid-treated patients. CONCLUSION: In patients hospitalised with COVID-19 pneumonia, corticosteroid use within the first 7 days of admission decreased mortality and ICU admissions with no associated increase in bacteraemia or fungaemia. |
format | Online Article Text |
id | pubmed-8023732 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-80237322021-04-08 Impact of corticosteroids in hospitalised COVID-19 patients Ho, Kam Sing Narasimhan, Bharat Difabrizio, Larry Rogers, Linda Bose, Sonali Li, Li Chen, Roger Sheehan, Jacqueline El-Halabi, Maan Ajwad Sarosky, Kimberly Wang, Zichen Eisenberg, Elliot Powell, Charles Steiger, David BMJ Open Respir Res Respiratory Infection BACKGROUND: Corticosteroids are a potential therapeutic agent for patients with COVID-19 pneumonia. The RECOVERY (Randomised Trials in COVID-19 Therapy) trial provided data on the mortality benefits of corticosteroids. The study aimed to determine the association between corticosteroid use on mortality and infection rates and to define subgroups who may benefit from corticosteroids in a real-world setting. METHODS: Clinical data were extracted that included demographic, laboratory data and details of the therapy, including the administration of corticosteroids, azithromycin, hydroxychloroquine, tocilizumab and anticoagulation. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) admission and invasive mechanical ventilation. Outcomes were compared in patients who did and did not receive corticosteroids using the multivariate Cox regression model. RESULTS: 4313 patients were hospitalised with COVID-19 during the study period, of whom 1270 died (29.4%). When administered within the first 7 days after admission, corticosteroids were associated with reduced mortality (OR 0.73, 95% CI 0.55 to 0.97, p=0.03) and decreased transfers to the ICU (OR 0.72, 95% CI 0.47 to 1.11, p=0.02). This mortality benefit was particularly impressive in younger patients (<65 years of age), females and those with elevated inflammatory markers, defined as C reactive protein ≥150 mg/L (p≤0.05), interleukin-6 ≥20 pg/mL (p≤0.05) or D-dimer ≥2.0 µg/L (p≤0.05). Therapy was safe with similar rates of bacteraemia and fungaemia in corticosteroid-treated and non-corticosteroid-treated patients. CONCLUSION: In patients hospitalised with COVID-19 pneumonia, corticosteroid use within the first 7 days of admission decreased mortality and ICU admissions with no associated increase in bacteraemia or fungaemia. BMJ Publishing Group 2021-04-02 /pmc/articles/PMC8023732/ /pubmed/33811098 http://dx.doi.org/10.1136/bmjresp-2020-000766 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Respiratory Infection Ho, Kam Sing Narasimhan, Bharat Difabrizio, Larry Rogers, Linda Bose, Sonali Li, Li Chen, Roger Sheehan, Jacqueline El-Halabi, Maan Ajwad Sarosky, Kimberly Wang, Zichen Eisenberg, Elliot Powell, Charles Steiger, David Impact of corticosteroids in hospitalised COVID-19 patients |
title | Impact of corticosteroids in hospitalised COVID-19 patients |
title_full | Impact of corticosteroids in hospitalised COVID-19 patients |
title_fullStr | Impact of corticosteroids in hospitalised COVID-19 patients |
title_full_unstemmed | Impact of corticosteroids in hospitalised COVID-19 patients |
title_short | Impact of corticosteroids in hospitalised COVID-19 patients |
title_sort | impact of corticosteroids in hospitalised covid-19 patients |
topic | Respiratory Infection |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023732/ https://www.ncbi.nlm.nih.gov/pubmed/33811098 http://dx.doi.org/10.1136/bmjresp-2020-000766 |
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