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Steroid exposure and outcome in COVID-19 pneumonia
BACKGROUND: Corticosteroids are used to treat COVID-19 pneumonia. However, the optimal dose is unclear. This study describes the association between corticosteroid exposure with disease severity and outcome in COVID-19 pneumonia. METHODS: This is a single-centre retrospective, observational study in...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886648/ https://www.ncbi.nlm.nih.gov/pubmed/36744291 http://dx.doi.org/10.1016/j.bjao.2023.100128 |
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author | Remmington, Christopher Barrett, Nicholas A Agarwal, Sangita Lams, Boris Collins, Patrick Camarda, Valentina Meadows, Chris Hanks, Fraser Sanderson, Barnaby Retter, Andrew Camporota, Luigi |
author_facet | Remmington, Christopher Barrett, Nicholas A Agarwal, Sangita Lams, Boris Collins, Patrick Camarda, Valentina Meadows, Chris Hanks, Fraser Sanderson, Barnaby Retter, Andrew Camporota, Luigi |
author_sort | Remmington, Christopher |
collection | PubMed |
description | BACKGROUND: Corticosteroids are used to treat COVID-19 pneumonia. However, the optimal dose is unclear. This study describes the association between corticosteroid exposure with disease severity and outcome in COVID-19 pneumonia. METHODS: This is a single-centre retrospective, observational study including adult ICU patients who received systemic corticosteroids for COVID-19 pneumonia between March 2020 and March 2021. We recorded patient characteristics, disease severity, total steroid exposure, respiratory support and gas exchange data, and 90-day mortality. RESULTS: We included 362 patients. We allocated patients to groups with increasing disease severity according to the highest level of respiratory support that they received: high-flow nasal oxygen or continuous positive airway pressure (HFNO/CPAP) in 12.7%, invasive mechanical ventilation (IMV) in 61.6%, and extracorporeal membrane oxygenation (ECMO) in 25.7%. For these three groups, the median (inter-quartile range [IQR]) age was 61 (54–71) vs 58 (50–66) vs 46 (38–53) yr, respectively (P<0.001); median (IQR) APACHE (Acute Physiology and Chronic Health Evaluation) II scores were 12 (9–15) vs 14 (12–18) vs 15 (12–17), respectively (P=0.006); the median (IQR) lowest [Formula: see text] /FiO(2) ratio was 15.1 (11.8–21.7) vs 15.1 (10.7–22.2) vs 9.5 (7.9–10.9) kPa, respectively (P<0.001). Ninety-day mortality was 9% vs 27% vs 37% (P=0.002). Median (IQR) dexamethasone-equivalent exposure was 37 (24–62) vs 174 (86–504) vs 535 (257–1213) mg (P<0.001). ‘Pulsed’ steroids were administered to 26% of the IMV group and 48% of the ECMO group. Patients with higher disease severity who received pulse steroids had a higher 90-day mortality. CONCLUSIONS: Corticosteroid exposure increased with the severity of COVID-19 pneumonia. Pulsed dose steroids were used more frequently in patients receiving greater respiratory support. Future studies should address patient selection and outcomes associated with pulsed dose steroids in patients with severe and deteriorating COVID-19 pneumonia. |
format | Online Article Text |
id | pubmed-9886648 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-98866482023-01-31 Steroid exposure and outcome in COVID-19 pneumonia Remmington, Christopher Barrett, Nicholas A Agarwal, Sangita Lams, Boris Collins, Patrick Camarda, Valentina Meadows, Chris Hanks, Fraser Sanderson, Barnaby Retter, Andrew Camporota, Luigi BJA Open Original Research Article BACKGROUND: Corticosteroids are used to treat COVID-19 pneumonia. However, the optimal dose is unclear. This study describes the association between corticosteroid exposure with disease severity and outcome in COVID-19 pneumonia. METHODS: This is a single-centre retrospective, observational study including adult ICU patients who received systemic corticosteroids for COVID-19 pneumonia between March 2020 and March 2021. We recorded patient characteristics, disease severity, total steroid exposure, respiratory support and gas exchange data, and 90-day mortality. RESULTS: We included 362 patients. We allocated patients to groups with increasing disease severity according to the highest level of respiratory support that they received: high-flow nasal oxygen or continuous positive airway pressure (HFNO/CPAP) in 12.7%, invasive mechanical ventilation (IMV) in 61.6%, and extracorporeal membrane oxygenation (ECMO) in 25.7%. For these three groups, the median (inter-quartile range [IQR]) age was 61 (54–71) vs 58 (50–66) vs 46 (38–53) yr, respectively (P<0.001); median (IQR) APACHE (Acute Physiology and Chronic Health Evaluation) II scores were 12 (9–15) vs 14 (12–18) vs 15 (12–17), respectively (P=0.006); the median (IQR) lowest [Formula: see text] /FiO(2) ratio was 15.1 (11.8–21.7) vs 15.1 (10.7–22.2) vs 9.5 (7.9–10.9) kPa, respectively (P<0.001). Ninety-day mortality was 9% vs 27% vs 37% (P=0.002). Median (IQR) dexamethasone-equivalent exposure was 37 (24–62) vs 174 (86–504) vs 535 (257–1213) mg (P<0.001). ‘Pulsed’ steroids were administered to 26% of the IMV group and 48% of the ECMO group. Patients with higher disease severity who received pulse steroids had a higher 90-day mortality. CONCLUSIONS: Corticosteroid exposure increased with the severity of COVID-19 pneumonia. Pulsed dose steroids were used more frequently in patients receiving greater respiratory support. Future studies should address patient selection and outcomes associated with pulsed dose steroids in patients with severe and deteriorating COVID-19 pneumonia. Elsevier 2023-01-31 /pmc/articles/PMC9886648/ /pubmed/36744291 http://dx.doi.org/10.1016/j.bjao.2023.100128 Text en © 2023 The Author(s) https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Original Research Article Remmington, Christopher Barrett, Nicholas A Agarwal, Sangita Lams, Boris Collins, Patrick Camarda, Valentina Meadows, Chris Hanks, Fraser Sanderson, Barnaby Retter, Andrew Camporota, Luigi Steroid exposure and outcome in COVID-19 pneumonia |
title | Steroid exposure and outcome in COVID-19 pneumonia |
title_full | Steroid exposure and outcome in COVID-19 pneumonia |
title_fullStr | Steroid exposure and outcome in COVID-19 pneumonia |
title_full_unstemmed | Steroid exposure and outcome in COVID-19 pneumonia |
title_short | Steroid exposure and outcome in COVID-19 pneumonia |
title_sort | steroid exposure and outcome in covid-19 pneumonia |
topic | Original Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886648/ https://www.ncbi.nlm.nih.gov/pubmed/36744291 http://dx.doi.org/10.1016/j.bjao.2023.100128 |
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