Do high-dose corticosteroids improve outcomes in hospitalized COVID-19 patients?

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Coronavirus disease 2019 (COVID-19) is characterized by dysregulated hyperimmune response and steroids have been shown to decrease mortality. However, whether higher dosing of steroids results in better outcomes has been debated. This was a retrospective observation of COVID-19 admissions between March 1, 2020, and March 10, 2021. Adult patients (≥18 years) who received more than 10 mg daily methylprednisolone equivalent dosing (MED) within the first 14 days were included. We excluded patients who were discharged or died within 7 days of admission. We compared the standard dose of steroids (<40 mg MED) versus the high dose of steroids (>40 mg MED). Inverse probability weighted regression adjustment (IPWRA) was used to examine whether higher dose steroids resulted in improved outcomes. The outcomes studied were in-hospital mortality, rate of acute kidney injury (AKI) requiring hemodialysis, invasive mechanical ventilation (IMV), hospital-associated infections (HAI), and readmissions. Of the 1379 patients meeting study criteria, 506 received less than 40 mg of MED (median dose 30 mg MED) and 873 received more than or equal to 40 mg of MED (median dose 78 mg MED). Unadjusted in-hospital mortality was higher in patients who received high-dose corticosteroids (40.7% vs. 18.6%, p < 0.001). On IPWRA, the use of high-dose corticosteroids was associated with higher odds of death (odds ratio [OR] 2.14; 95% confidence interval [CI] 1.45-3.14, p < 0.001) but not with the development of HAI, readmissions, or requirement of IMV. High-dose corticosteroids were associated with lower rates of AKI requiring hemodialysis (OR 0.33; 95% CI 0.18-0.63). In COVID-19, corticosteroids more than or equal to 40 mg MED were associated with higher in-hospital mortality.

Media Type:

Electronic Article

Year of Publication:

2021

Contained In:

Journal of medical virology - Vol. 94, No. 1 (2021), p. 372-379

Language:

English

Contributors:

Kumar, Gagan
Patel, Dhaval
Hererra, Martin
Jefferies, David
Sakhuja, Ankit
Meersman, Mark
Dalton, Drew
Nanchal, Rahul
Guddati, Achuta Kumar

Links:

Volltext

Keywords:

Acute Kidney Injury
Adrenal Cortex Hormones
Aged
Aged, 80 and over
COVID-19
Corticosteroids
Cross Infection
Female
Hospital Mortality
Humans
Journal Article
Male
Methylprednisolone
Middle Aged
Observational Study
Outcomes
Research Support, N.I.H., Extramural
Respiration, Artificial
Retrospective Studies
SARS-CoV-2
X4W7ZR7023

Notes:

Date Completed 23.11.2021

Date Revised 23.11.2021

published: Print-Electronic

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1002/jmv.27357

PMID:

34559436

PPN (Catalogue-ID):

NLM332211401