The adverse effects of high-dose corticosteroid on infectious and non-infectious sequelae in renal transplant recipients with coronavirus disease-19 in India
© 2022 Wiley Periodicals LLC..
INTRODUCTION: The corticosteroid dosing modulation in renal transplant recipients (RTRs) with coronavirus disease-19 (COVID-19) is not well defined. We aimed to analyze the outcomes and infectious and non-infectious sequelae in RTR with COVID-19 with reference to corticosteroid dosing and the first and second pandemic waves of COVID-19.
MATERIALS AND METHODS: This study included RTRs admitted during two pandemic waves between March 25, 2020, and July 31, 2021. Patients were categorized into mild, moderate, and severe COVID-19. The outcomes and predictors of survival at 4 weeks were analyzed. The survivors were also followed for 6 months and were studied for mortality, readmission rates, and infectious and non-infectious sequelae with reference to high-dose and standard-dose corticosteroids.
RESULTS: A total of 251 RTRs, 104 during the first wave and 147 during the second wave, were treated. Overall mortality was 15.1% (11.5% in the first wave vs. 17.5% in the second wave, p = .23). The use of high-dose steroids was also significantly high in non-survivors (85.8% vs. 11.3%, p = .001). On multivariate analysis, the severity of COVID-19, graft dysfunction, and high dose of corticosteroid therapy were associated with increased odds of mortality. Among survivors, 6-month mortality (17.3% vs. 0.5%, p = .001), readmission rate (91.3% vs. 23.7%, p = .001), fungal infection (30.4% vs. 2.2%, p < .001), and post-COVID lung sequelae (21.7% vs. 4.4%, p = .008) were significantly higher in the high-dose corticosteroid group than in the standard-dose group.
CONCLUSION: High-dose corticosteroid dosing in RTRs with COVID-19 was associated with increased infections, particularly fungal infections, and non-infectious sequelae with higher mortality on subsequent follow-up.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
Transplant infectious disease : an official journal of the Transplantation Society - 24(2022), 6 vom: 12. Dez., Seite e13908 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Veeranki, Vamsidhar [VerfasserIn] |
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| Links: |
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| Themen: |
Adrenal Cortex Hormones |
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| Anmerkungen: |
Date Completed 23.12.2022 Date Revised 23.12.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/tid.13908 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 4 | |a The adverse effects of high-dose corticosteroid on infectious and non-infectious sequelae in renal transplant recipients with coronavirus disease-19 in India |
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| 520 | |a © 2022 Wiley Periodicals LLC. | ||
| 520 | |a INTRODUCTION: The corticosteroid dosing modulation in renal transplant recipients (RTRs) with coronavirus disease-19 (COVID-19) is not well defined. We aimed to analyze the outcomes and infectious and non-infectious sequelae in RTR with COVID-19 with reference to corticosteroid dosing and the first and second pandemic waves of COVID-19 | ||
| 520 | |a MATERIALS AND METHODS: This study included RTRs admitted during two pandemic waves between March 25, 2020, and July 31, 2021. Patients were categorized into mild, moderate, and severe COVID-19. The outcomes and predictors of survival at 4 weeks were analyzed. The survivors were also followed for 6 months and were studied for mortality, readmission rates, and infectious and non-infectious sequelae with reference to high-dose and standard-dose corticosteroids | ||
| 520 | |a RESULTS: A total of 251 RTRs, 104 during the first wave and 147 during the second wave, were treated. Overall mortality was 15.1% (11.5% in the first wave vs. 17.5% in the second wave, p = .23). The use of high-dose steroids was also significantly high in non-survivors (85.8% vs. 11.3%, p = .001). On multivariate analysis, the severity of COVID-19, graft dysfunction, and high dose of corticosteroid therapy were associated with increased odds of mortality. Among survivors, 6-month mortality (17.3% vs. 0.5%, p = .001), readmission rate (91.3% vs. 23.7%, p = .001), fungal infection (30.4% vs. 2.2%, p < .001), and post-COVID lung sequelae (21.7% vs. 4.4%, p = .008) were significantly higher in the high-dose corticosteroid group than in the standard-dose group | ||
| 520 | |a CONCLUSION: High-dose corticosteroid dosing in RTRs with COVID-19 was associated with increased infections, particularly fungal infections, and non-infectious sequelae with higher mortality on subsequent follow-up | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a coronavirus disease-19 | |
| 650 | 4 | |a high-dose corticosteroids | |
| 650 | 4 | |a renal transplant recipients | |
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| 700 | 1 | |a Prasad, Narayan |e verfasserin |4 aut | |
| 700 | 1 | |a Meyyappan, Jeyakumar |e verfasserin |4 aut | |
| 700 | 1 | |a Bhadauria, Dharmendra |e verfasserin |4 aut | |
| 700 | 1 | |a Behera, Manas R |e verfasserin |4 aut | |
| 700 | 1 | |a Kushwaha, Ravi |e verfasserin |4 aut | |
| 700 | 1 | |a Patel, Manas R |e verfasserin |4 aut | |
| 700 | 1 | |a Yaccha, Monika |e verfasserin |4 aut | |
| 700 | 1 | |a Kaul, Anupama |e verfasserin |4 aut | |
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