Impact of Early Corticosteroids on Preventing Clinical Deterioration in Non-critically Ill Patients Hospitalized with COVID-19 : A Multi-hospital Cohort Study
© 2022. The Author(s)..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:11 |
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| Enthalten in: |
Infectious diseases and therapy - 11(2022), 2 vom: 10. Apr., Seite 887-898 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Swaminathan, Lakshmi [VerfasserIn] |
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| Links: |
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| Themen: |
COVID-19 therapeutics |
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| Anmerkungen: |
Date Revised 29.03.2022 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1007/s40121-022-00615-x |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM337980217 |
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| 500 | |a Date Revised 29.03.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2022. The Author(s). | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a COVID-19 therapeutics | |
| 650 | 4 | |a Corticosteroid therapy | |
| 650 | 4 | |a SARS-COV2 | |
| 650 | 4 | |a Viral infections | |
| 700 | 1 | |a Kaatz, Scott |e verfasserin |4 aut | |
| 700 | 1 | |a Chubb, Heather |e verfasserin |4 aut | |
| 700 | 1 | |a Tae, Kim |e verfasserin |4 aut | |
| 700 | 1 | |a Ramesh, Mayur S |e verfasserin |4 aut | |
| 700 | 1 | |a Fadel, Raef |e verfasserin |4 aut | |
| 700 | 1 | |a Big, Cecilia |e verfasserin |4 aut | |
| 700 | 1 | |a Jones, Jessica |e verfasserin |4 aut | |
| 700 | 1 | |a Flanders, Scott A |e verfasserin |4 aut | |
| 700 | 1 | |a Prescott, Hallie C |e verfasserin |4 aut | |
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