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Impact of Early Corticosteroids on Preventing Clinical Deterioration in Non-critically Ill Patients Hospitalized with COVID-19: A Multi-hospital Cohort Study

INTRODUCTION: While guidelines stronglyrecommend dexamethasone in critical COVID-19, the optimal threshold to initiate corticosteroids in non-critically ill patients with COVID-19 remains unclear. Using data from a state-wide COVID-19 registry, we evaluated the effectiveness of early corticosteroids...

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Autores principales: Swaminathan, Lakshmi, Kaatz, Scott, Chubb, Heather, Tae, Kim, Ramesh, Mayur S., Fadel, Raef, Big, Cecilia, Jones, Jessica, Flanders, Scott A., Prescott, Hallie C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8908754/
https://www.ncbi.nlm.nih.gov/pubmed/35267172
http://dx.doi.org/10.1007/s40121-022-00615-x
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author Swaminathan, Lakshmi
Kaatz, Scott
Chubb, Heather
Tae, Kim
Ramesh, Mayur S.
Fadel, Raef
Big, Cecilia
Jones, Jessica
Flanders, Scott A.
Prescott, Hallie C.
author_facet Swaminathan, Lakshmi
Kaatz, Scott
Chubb, Heather
Tae, Kim
Ramesh, Mayur S.
Fadel, Raef
Big, Cecilia
Jones, Jessica
Flanders, Scott A.
Prescott, Hallie C.
author_sort Swaminathan, Lakshmi
collection PubMed
description INTRODUCTION: While guidelines stronglyrecommend dexamethasone in critical COVID-19, the optimal threshold to initiate corticosteroids in non-critically ill patients with COVID-19 remains unclear. Using data from a state-wide COVID-19 registry, we evaluated the effectiveness of early corticosteroids for preventing clinical deterioration among non-critically ill patients hospitalized for COVID-19 and receiving non-invasive oxygen therapy. METHODS: This was a target trial using observational data from patients hospitalized for COVID-19 at 39 hospitals participating in the MI-COVID19 registry between March 16, 2020 and August 24, 2020. We studied the impact of corticosteroids initiated within 2 calendar days of hospitalization (“early steroids”) versus no early steroids among non-ICU patients with laboratory-confirmed SARS-CoV2 receiving non-invasive supplemental oxygen therapy. Our primary outcome was a composite of in-hospital mortality, transfer to intensive care, and receipt of invasive mechanical ventilation. We used inverse probability of treatment weighting (IPTW) and propensity score-weighted regression to measure the association of early steroids and outcomes. RESULTS: Among 1002 patients meeting study criteria, 231 (23.1%) received early steroids. After IPTW, to balance potential confounders between the treatment groups, early steroids were not associated with a decrease in the composite outcome (aOR 1.1, 95%CI 0.8–1.6) or in any components of the primary outcome. CONCLUSION: We found no evidence that early corticosteroid therapy prevents clinical deterioration among hospitalized non-critically ill COVID-19 patients receiving non-invasive oxygen therapy. Further studies are needed to determine the optimal threshold for initiating corticosteroids in this population. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40121-022-00615-x.
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spelling pubmed-89087542022-03-10 Impact of Early Corticosteroids on Preventing Clinical Deterioration in Non-critically Ill Patients Hospitalized with COVID-19: A Multi-hospital Cohort Study Swaminathan, Lakshmi Kaatz, Scott Chubb, Heather Tae, Kim Ramesh, Mayur S. Fadel, Raef Big, Cecilia Jones, Jessica Flanders, Scott A. Prescott, Hallie C. Infect Dis Ther Original Research INTRODUCTION: While guidelines stronglyrecommend dexamethasone in critical COVID-19, the optimal threshold to initiate corticosteroids in non-critically ill patients with COVID-19 remains unclear. Using data from a state-wide COVID-19 registry, we evaluated the effectiveness of early corticosteroids for preventing clinical deterioration among non-critically ill patients hospitalized for COVID-19 and receiving non-invasive oxygen therapy. METHODS: This was a target trial using observational data from patients hospitalized for COVID-19 at 39 hospitals participating in the MI-COVID19 registry between March 16, 2020 and August 24, 2020. We studied the impact of corticosteroids initiated within 2 calendar days of hospitalization (“early steroids”) versus no early steroids among non-ICU patients with laboratory-confirmed SARS-CoV2 receiving non-invasive supplemental oxygen therapy. Our primary outcome was a composite of in-hospital mortality, transfer to intensive care, and receipt of invasive mechanical ventilation. We used inverse probability of treatment weighting (IPTW) and propensity score-weighted regression to measure the association of early steroids and outcomes. RESULTS: Among 1002 patients meeting study criteria, 231 (23.1%) received early steroids. After IPTW, to balance potential confounders between the treatment groups, early steroids were not associated with a decrease in the composite outcome (aOR 1.1, 95%CI 0.8–1.6) or in any components of the primary outcome. CONCLUSION: We found no evidence that early corticosteroid therapy prevents clinical deterioration among hospitalized non-critically ill COVID-19 patients receiving non-invasive oxygen therapy. Further studies are needed to determine the optimal threshold for initiating corticosteroids in this population. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40121-022-00615-x. Springer Healthcare 2022-03-10 2022-04 /pmc/articles/PMC8908754/ /pubmed/35267172 http://dx.doi.org/10.1007/s40121-022-00615-x Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Swaminathan, Lakshmi
Kaatz, Scott
Chubb, Heather
Tae, Kim
Ramesh, Mayur S.
Fadel, Raef
Big, Cecilia
Jones, Jessica
Flanders, Scott A.
Prescott, Hallie C.
Impact of Early Corticosteroids on Preventing Clinical Deterioration in Non-critically Ill Patients Hospitalized with COVID-19: A Multi-hospital Cohort Study
title Impact of Early Corticosteroids on Preventing Clinical Deterioration in Non-critically Ill Patients Hospitalized with COVID-19: A Multi-hospital Cohort Study
title_full Impact of Early Corticosteroids on Preventing Clinical Deterioration in Non-critically Ill Patients Hospitalized with COVID-19: A Multi-hospital Cohort Study
title_fullStr Impact of Early Corticosteroids on Preventing Clinical Deterioration in Non-critically Ill Patients Hospitalized with COVID-19: A Multi-hospital Cohort Study
title_full_unstemmed Impact of Early Corticosteroids on Preventing Clinical Deterioration in Non-critically Ill Patients Hospitalized with COVID-19: A Multi-hospital Cohort Study
title_short Impact of Early Corticosteroids on Preventing Clinical Deterioration in Non-critically Ill Patients Hospitalized with COVID-19: A Multi-hospital Cohort Study
title_sort impact of early corticosteroids on preventing clinical deterioration in non-critically ill patients hospitalized with covid-19: a multi-hospital cohort study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8908754/
https://www.ncbi.nlm.nih.gov/pubmed/35267172
http://dx.doi.org/10.1007/s40121-022-00615-x
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