IMPACT OF GLUCOCORTICOID TREATMENT IN SARS-COV-2 INFECTION MORTALITY: A RETROSPECTIVE CONTROLLED COHORT STUDY
ABSTRACT Objective We aim to determine the impact of steroid use in COVID-19 pneumonia in-hospital mortality.Design We performed a single-centre retrospective cohort study.Setting A University hospital in Madrid, Spain, during March 2020.Participants Patients admitted with SARS-CoV-2 pneumonia.Exposures Patients treated with steroids were compared to patients not treated with steroids. A propensity-score for steroid treatment was developed. Different steroid regimens were also compared, and adjusted with a second propensity score.Main Outcomes and Measures To determine the role of steroids in in-hospital mortality, univariable and multivariable analyses were performed, and adjusted including the propensity score as a covariate. Survival times were compared using a log-rank test.Results During the study period, 463 out of 848 hospitalized patients with COVID19 pneumonia fulfilled inclusion criteria. Among them, 396 (46.7%) consecutive patients were treated with steroids and 67 patients were assigned to the control cohort. Global mortality was 15.1%. Median time to steroid treatment from symptom onset was 10 days (IQR 8 to13). In-hospital mortality was lower in patients treated with steroids than in controls (13.9% [55/396] versus 23.9% [16/67], OR 0.51 [0.27 to 0.96], p= 0.044). Steroid treatment reduced mortality by 41.8% relative to no steroid treatment (RRR 0,42 [0.048 to 0.65). Initial treatment with 1 mg/kg/day of methylprednisolone (or equivalent) versus steroid pulses was not associated with in-hospital mortality (13.5% [42/310] versus 15.1% [13/86], OR 0.880 [0.449-1.726], p=0.710).Conclusions Our results show that survival of patients with SARS-CoV2 pneumonia is higher in patients treated with glucocorticoids than in those not treated. In-hospital mortality was not different between initial regimens of 1 mg/kg/day of methylprednisolone or equivalent and glucocorticoid pulses. These results support the use of glucocorticoids in SARS-CoV2 infection.Summary We investigated in-hospital mortality of patients with SARS-CoV-2 pneumonia in a large series of patients treated with steroids compared to controls, and adjusted using a propensity score. Our results show a beneficial impact of steroid treatment in SARS-CoV-2 pneumonia..
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Preprint| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
bioRxiv.org - (2022) vom: 25. Okt. Zur Gesamtaufnahme - year:2022 |
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| Sprache: |
Englisch |
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| Beteiligte Personen: |
Fernández Cruz, Ana [VerfasserIn] |
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| doi: |
10.1101/2020.05.22.20110544 |
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| PPN (Katalog-ID): |
XBI017998018 |
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| 100 | 1 | |a Fernández Cruz, Ana |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a IMPACT OF GLUCOCORTICOID TREATMENT IN SARS-COV-2 INFECTION MORTALITY: A RETROSPECTIVE CONTROLLED COHORT STUDY |
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| 520 | |a ABSTRACT Objective We aim to determine the impact of steroid use in COVID-19 pneumonia in-hospital mortality.Design We performed a single-centre retrospective cohort study.Setting A University hospital in Madrid, Spain, during March 2020.Participants Patients admitted with SARS-CoV-2 pneumonia.Exposures Patients treated with steroids were compared to patients not treated with steroids. A propensity-score for steroid treatment was developed. Different steroid regimens were also compared, and adjusted with a second propensity score.Main Outcomes and Measures To determine the role of steroids in in-hospital mortality, univariable and multivariable analyses were performed, and adjusted including the propensity score as a covariate. Survival times were compared using a log-rank test.Results During the study period, 463 out of 848 hospitalized patients with COVID19 pneumonia fulfilled inclusion criteria. Among them, 396 (46.7%) consecutive patients were treated with steroids and 67 patients were assigned to the control cohort. Global mortality was 15.1%. Median time to steroid treatment from symptom onset was 10 days (IQR 8 to13). In-hospital mortality was lower in patients treated with steroids than in controls (13.9% [55/396] versus 23.9% [16/67], OR 0.51 [0.27 to 0.96], p= 0.044). Steroid treatment reduced mortality by 41.8% relative to no steroid treatment (RRR 0,42 [0.048 to 0.65). Initial treatment with 1 mg/kg/day of methylprednisolone (or equivalent) versus steroid pulses was not associated with in-hospital mortality (13.5% [42/310] versus 15.1% [13/86], OR 0.880 [0.449-1.726], p=0.710).Conclusions Our results show that survival of patients with SARS-CoV2 pneumonia is higher in patients treated with glucocorticoids than in those not treated. In-hospital mortality was not different between initial regimens of 1 mg/kg/day of methylprednisolone or equivalent and glucocorticoid pulses. These results support the use of glucocorticoids in SARS-CoV2 infection.Summary We investigated in-hospital mortality of patients with SARS-CoV-2 pneumonia in a large series of patients treated with steroids compared to controls, and adjusted using a propensity score. Our results show a beneficial impact of steroid treatment in SARS-CoV-2 pneumonia. | ||
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| 700 | 1 | |a Ruiz-Antorán, Belén |e verfasserin |4 aut | |
| 700 | 1 | |a Gómez, Ana Muñoz |e verfasserin |4 aut | |
| 700 | 1 | |a Sancho López, Aránzazu |e verfasserin |4 aut | |
| 700 | 1 | |a Sánchez, Patricia Mills |e verfasserin |4 aut | |
| 700 | 1 | |a Soto, Gustavo Adolfo Centeno |e verfasserin |4 aut | |
| 700 | 1 | |a Alonso, Silvia Blanco |e verfasserin |4 aut | |
| 700 | 1 | |a Garachana, Laura Javaloyes |e verfasserin |4 aut | |
| 700 | 1 | |a Gómez, Amy Galán |e verfasserin |4 aut | |
| 700 | 1 | |a Alijo, Ángela Valencia |e verfasserin |4 aut | |
| 700 | 1 | |a Irusta, Javier Gómez |e verfasserin |4 aut | |
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