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Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients Treated with Standard Dose of Dexamethasone or High Dose of Methylprednisolone

The hyperinflammatory phase represents the main cause for the clinical worsening of acute respiratory distress syndrome (ARDS) in Coronavirus disease 2019 (COVID-19), leading to the hypothesis that steroid therapy could be a mainstream treatment in COVID-19 patients. This is an observational study i...

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Autores principales: Russo, Alessandro, Davoli, Chiara, Borrazzo, Cristian, Olivadese, Vincenzo, Ceccarelli, Giancarlo, Fusco, Paolo, Lazzaro, Alessandro, Lionello, Rosaria, Ricchio, Marco, Serapide, Francesca, Tassone, Bruno, Gentilini Cacciola, Elio, Mastroianni, Claudio Maria, Torti, Carlo, d’Ettorre, Gabriella, Trecarichi, Enrico Maria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9312892/
https://www.ncbi.nlm.nih.gov/pubmed/35884852
http://dx.doi.org/10.3390/biomedicines10071548
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author Russo, Alessandro
Davoli, Chiara
Borrazzo, Cristian
Olivadese, Vincenzo
Ceccarelli, Giancarlo
Fusco, Paolo
Lazzaro, Alessandro
Lionello, Rosaria
Ricchio, Marco
Serapide, Francesca
Tassone, Bruno
Gentilini Cacciola, Elio
Mastroianni, Claudio Maria
Torti, Carlo
d’Ettorre, Gabriella
Trecarichi, Enrico Maria
author_facet Russo, Alessandro
Davoli, Chiara
Borrazzo, Cristian
Olivadese, Vincenzo
Ceccarelli, Giancarlo
Fusco, Paolo
Lazzaro, Alessandro
Lionello, Rosaria
Ricchio, Marco
Serapide, Francesca
Tassone, Bruno
Gentilini Cacciola, Elio
Mastroianni, Claudio Maria
Torti, Carlo
d’Ettorre, Gabriella
Trecarichi, Enrico Maria
author_sort Russo, Alessandro
collection PubMed
description The hyperinflammatory phase represents the main cause for the clinical worsening of acute respiratory distress syndrome (ARDS) in Coronavirus disease 2019 (COVID-19), leading to the hypothesis that steroid therapy could be a mainstream treatment in COVID-19 patients. This is an observational study including all consecutive patients admitted to two Italian University Hospitals for COVID-19 from March 2020 to December 2021. The aim of this study was to describe clinical characteristics and outcome parameters of hospitalized COVID-19 patients treated with dexamethasone 6 mg once daily (standard-dose group) or methylprednisolone 40 mg twice daily (high-dose group). The primary outcome was the impact of these different steroid treatments on 30-day mortality. During the study period, 990 patients were evaluated: 695 (70.2%) receiving standard dosage of dexamethasone and 295 (29.8%) receiving a high dose of methylprednisolone. Cox regression analysis showed that chronic obstructive pulmonary disease (HR 1.98, CI95% 1.34–9.81, p = 0.002), chronic kidney disease (HR 5.21, CI95% 1.48–22.23, p = 0.001), oncologic disease (HR 2.81, CI95% 1.45–19.8, p = 0.005) and high-flow nasal cannula, continuous positive airway pressure or non-invasive ventilation oxygen therapy (HR 61.1, CI95% 5.12–511.1, p < 0.001) were independently associated with 30-day mortality; conversely, high-dose steroid therapy was associated with survival (HR 0.42, CI95% 0.38–0.86, p = 0.002) at 30 days. Kaplan–Meier curves for 30-day survival displayed a statistically significant better survival rate in patients treated with high-dose steroid therapy (p = 0.018). The results of this study highlighted that the use of high-dose methylprednisolone, compared to dexamethasone 6 mg once daily, in hospitalized patients with COVID-19 may be associated with a significant reduction in mortality.
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spelling pubmed-93128922022-07-26 Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients Treated with Standard Dose of Dexamethasone or High Dose of Methylprednisolone Russo, Alessandro Davoli, Chiara Borrazzo, Cristian Olivadese, Vincenzo Ceccarelli, Giancarlo Fusco, Paolo Lazzaro, Alessandro Lionello, Rosaria Ricchio, Marco Serapide, Francesca Tassone, Bruno Gentilini Cacciola, Elio Mastroianni, Claudio Maria Torti, Carlo d’Ettorre, Gabriella Trecarichi, Enrico Maria Biomedicines Article The hyperinflammatory phase represents the main cause for the clinical worsening of acute respiratory distress syndrome (ARDS) in Coronavirus disease 2019 (COVID-19), leading to the hypothesis that steroid therapy could be a mainstream treatment in COVID-19 patients. This is an observational study including all consecutive patients admitted to two Italian University Hospitals for COVID-19 from March 2020 to December 2021. The aim of this study was to describe clinical characteristics and outcome parameters of hospitalized COVID-19 patients treated with dexamethasone 6 mg once daily (standard-dose group) or methylprednisolone 40 mg twice daily (high-dose group). The primary outcome was the impact of these different steroid treatments on 30-day mortality. During the study period, 990 patients were evaluated: 695 (70.2%) receiving standard dosage of dexamethasone and 295 (29.8%) receiving a high dose of methylprednisolone. Cox regression analysis showed that chronic obstructive pulmonary disease (HR 1.98, CI95% 1.34–9.81, p = 0.002), chronic kidney disease (HR 5.21, CI95% 1.48–22.23, p = 0.001), oncologic disease (HR 2.81, CI95% 1.45–19.8, p = 0.005) and high-flow nasal cannula, continuous positive airway pressure or non-invasive ventilation oxygen therapy (HR 61.1, CI95% 5.12–511.1, p < 0.001) were independently associated with 30-day mortality; conversely, high-dose steroid therapy was associated with survival (HR 0.42, CI95% 0.38–0.86, p = 0.002) at 30 days. Kaplan–Meier curves for 30-day survival displayed a statistically significant better survival rate in patients treated with high-dose steroid therapy (p = 0.018). The results of this study highlighted that the use of high-dose methylprednisolone, compared to dexamethasone 6 mg once daily, in hospitalized patients with COVID-19 may be associated with a significant reduction in mortality. MDPI 2022-06-29 /pmc/articles/PMC9312892/ /pubmed/35884852 http://dx.doi.org/10.3390/biomedicines10071548 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Russo, Alessandro
Davoli, Chiara
Borrazzo, Cristian
Olivadese, Vincenzo
Ceccarelli, Giancarlo
Fusco, Paolo
Lazzaro, Alessandro
Lionello, Rosaria
Ricchio, Marco
Serapide, Francesca
Tassone, Bruno
Gentilini Cacciola, Elio
Mastroianni, Claudio Maria
Torti, Carlo
d’Ettorre, Gabriella
Trecarichi, Enrico Maria
Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients Treated with Standard Dose of Dexamethasone or High Dose of Methylprednisolone
title Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients Treated with Standard Dose of Dexamethasone or High Dose of Methylprednisolone
title_full Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients Treated with Standard Dose of Dexamethasone or High Dose of Methylprednisolone
title_fullStr Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients Treated with Standard Dose of Dexamethasone or High Dose of Methylprednisolone
title_full_unstemmed Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients Treated with Standard Dose of Dexamethasone or High Dose of Methylprednisolone
title_short Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients Treated with Standard Dose of Dexamethasone or High Dose of Methylprednisolone
title_sort clinical characteristics and outcome of hospitalized covid-19 patients treated with standard dose of dexamethasone or high dose of methylprednisolone
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9312892/
https://www.ncbi.nlm.nih.gov/pubmed/35884852
http://dx.doi.org/10.3390/biomedicines10071548
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