A Retrospective Controlled Cohort Study of the Impact of Glucocorticoid Treatment in SARS-CoV-2 Infection Mortality
Copyright © 2020 Fernández-Cruz et al..
Evidence to support the use of steroids in coronavirus disease 2019 (COVID-19) pneumonia is lacking. We aim to determine the impact of steroid use for COVID-19 pneumonia on hospital mortality. We performed a single-center retrospective cohort study in a university hospital in Madrid, Spain, during March of 2020. To determine the role of steroids in in-hospital mortality, patients admitted with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia and treated with steroids were compared to patients not treated with steroids, and we adjusted with a propensity score for patients on steroid treatment. Survival times were compared using the log rank test. Different steroid regimens were compared and adjusted with a second propensity score. During the study period, 463 out of 848 hospitalized patients with COVID-19 pneumonia fulfilled inclusion criteria. Among them, 396 (46.7%) patients were treated with steroids and 67 patients were not. Global mortality was 15.1%. The median time to steroid treatment from symptom onset was 10 days (interquartile range [IQR], 8 to 13 days). In-hospital mortality was lower in patients treated with steroids than in controls (13.9% [55/396] versus 23.9% [16/67]; hazard ratio [HR], 0.51 [95% confidence interval, 0.27 to 0.96]; P = 0.044). Steroid treatment reduced mortality by 41.8% relative to the mortality with no steroid treatment (relative risk reduction, 0.42 [95% confidence interval, 0.048 to 0.65]). Initial treatment with 1 mg/kg of body weight/day of methylprednisolone versus steroid pulses was not associated with in-hospital mortality (13.5% [42/310] versus 15.1% [13/86]; odds ratio [OR], 0.880 [95% confidence interval, 0.449 to 1.726]; P = 0.710). Our results show that the survival of patients with SARS-CoV-2 pneumonia is higher in patients treated with glucocorticoids than in those not treated. Rates of in-hospital mortality were not different between initial regimens of 1 mg/kg/day of methylprednisolone and glucocorticoid pulses.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2020 |
|---|---|
| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:64 |
|---|---|
| Enthalten in: |
Antimicrobial agents and chemotherapy - 64(2020), 9 vom: 20. Aug. |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Fernández-Cruz, Ana [VerfasserIn] |
|---|
| Links: |
|---|
| Anmerkungen: |
Date Completed 02.09.2020 Date Revised 29.03.2024 published: Electronic-Print Citation Status MEDLINE |
|---|
| doi: |
10.1128/AAC.01168-20 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM311503829 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM311503829 | ||
| 003 | DE-627 | ||
| 005 | 20240329233007.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2020 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1128/AAC.01168-20 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1354.xml |
| 035 | |a (DE-627)NLM311503829 | ||
| 035 | |a (NLM)32571831 | ||
| 035 | |a (PII)e01168-20 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Fernández-Cruz, Ana |e verfasserin |4 aut | |
| 245 | 1 | 2 | |a A Retrospective Controlled Cohort Study of the Impact of Glucocorticoid Treatment in SARS-CoV-2 Infection Mortality |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 02.09.2020 | ||
| 500 | |a Date Revised 29.03.2024 | ||
| 500 | |a published: Electronic-Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Fernández-Cruz et al. | ||
| 520 | |a Evidence to support the use of steroids in coronavirus disease 2019 (COVID-19) pneumonia is lacking. We aim to determine the impact of steroid use for COVID-19 pneumonia on hospital mortality. We performed a single-center retrospective cohort study in a university hospital in Madrid, Spain, during March of 2020. To determine the role of steroids in in-hospital mortality, patients admitted with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia and treated with steroids were compared to patients not treated with steroids, and we adjusted with a propensity score for patients on steroid treatment. Survival times were compared using the log rank test. Different steroid regimens were compared and adjusted with a second propensity score. During the study period, 463 out of 848 hospitalized patients with COVID-19 pneumonia fulfilled inclusion criteria. Among them, 396 (46.7%) patients were treated with steroids and 67 patients were not. Global mortality was 15.1%. The median time to steroid treatment from symptom onset was 10 days (interquartile range [IQR], 8 to 13 days). In-hospital mortality was lower in patients treated with steroids than in controls (13.9% [55/396] versus 23.9% [16/67]; hazard ratio [HR], 0.51 [95% confidence interval, 0.27 to 0.96]; P = 0.044). Steroid treatment reduced mortality by 41.8% relative to the mortality with no steroid treatment (relative risk reduction, 0.42 [95% confidence interval, 0.048 to 0.65]). Initial treatment with 1 mg/kg of body weight/day of methylprednisolone versus steroid pulses was not associated with in-hospital mortality (13.5% [42/310] versus 15.1% [13/86]; odds ratio [OR], 0.880 [95% confidence interval, 0.449 to 1.726]; P = 0.710). Our results show that the survival of patients with SARS-CoV-2 pneumonia is higher in patients treated with glucocorticoids than in those not treated. Rates of in-hospital mortality were not different between initial regimens of 1 mg/kg/day of methylprednisolone and glucocorticoid pulses | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a mortality | |
| 650 | 4 | |a steroids | |
| 650 | 7 | |a Antiviral Agents |2 NLM | |
| 650 | 7 | |a Drug Combinations |2 NLM | |
| 650 | 7 | |a lopinavir-ritonavir drug combination |2 NLM | |
| 650 | 7 | |a Lopinavir |2 NLM | |
| 650 | 7 | |a 2494G1JF75 |2 NLM | |
| 650 | 7 | |a Hydroxychloroquine |2 NLM | |
| 650 | 7 | |a 4QWG6N8QKH |2 NLM | |
| 650 | 7 | |a Azithromycin |2 NLM | |
| 650 | 7 | |a 83905-01-5 |2 NLM | |
| 650 | 7 | |a Interferons |2 NLM | |
| 650 | 7 | |a 9008-11-1 |2 NLM | |
| 650 | 7 | |a Ritonavir |2 NLM | |
| 650 | 7 | |a O3J8G9O825 |2 NLM | |
| 650 | 7 | |a Methylprednisolone |2 NLM | |
| 650 | 7 | |a X4W7ZR7023 |2 NLM | |
| 700 | 1 | |a Ruiz-Antorán, Belén |e verfasserin |4 aut | |
| 700 | 1 | |a Muñoz-Gómez, Ana |e verfasserin |4 aut | |
| 700 | 1 | |a Sancho-López, Aránzazu |e verfasserin |4 aut | |
| 700 | 1 | |a Mills-Sánchez, Patricia |e verfasserin |4 aut | |
| 700 | 1 | |a Centeno-Soto, Gustavo Adolfo |e verfasserin |4 aut | |
| 700 | 1 | |a Blanco-Alonso, Silvia |e verfasserin |4 aut | |
| 700 | 1 | |a Javaloyes-Garachana, Laura |e verfasserin |4 aut | |
| 700 | 1 | |a Galán-Gómez, Amy |e verfasserin |4 aut | |
| 700 | 1 | |a Valencia-Alijo, Ángela |e verfasserin |4 aut | |
| 700 | 1 | |a Gómez-Irusta, Javier |e verfasserin |4 aut | |
| 700 | 1 | |a Payares-Herrera, Concepción |e verfasserin |4 aut | |
| 700 | 1 | |a Morrás-Torre, Ignacio |e verfasserin |4 aut | |
| 700 | 1 | |a Sánchez-Chica, Enrique |e verfasserin |4 aut | |
| 700 | 1 | |a Delgado-Téllez-de-Cepeda, Laura |e verfasserin |4 aut | |
| 700 | 1 | |a Callejas-Díaz, Alejandro |e verfasserin |4 aut | |
| 700 | 1 | |a Ramos-Martínez, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Múñez-Rubio, Elena |e verfasserin |4 aut | |
| 700 | 1 | |a Avendaño-Solá, Cristina |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Antimicrobial agents and chemotherapy |d 1972 |g 64(2020), 9 vom: 20. Aug. |w (DE-627)NLM000026506 |x 1098-6596 |7 nnns |
| 773 | 1 | 8 | |g volume:64 |g year:2020 |g number:9 |g day:20 |g month:08 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1128/AAC.01168-20 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 64 |j 2020 |e 9 |b 20 |c 08 | ||