Corticosteroid Pulses for Hospitalized Patients with COVID-19: Effects on Mortality
Objectives. To assess the influence of corticosteroid pulses on 60-day mortality in hospitalized patients with severe COVID-19. Methods. We designed a multicenter retrospective cohort study in three teaching hospitals of Castilla y León, Spain (865,096 people). We selected patients with confirmed CO...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Mediators of Inflammation |
| Online Access: | http://dx.doi.org/10.1155/2021/6637227 |
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| author | Ivan Cusacovich Álvaro Aparisi Miguel Marcos Cristina Ybarra-Falcón Carolina Iglesias-Echevarria Maria Lopez-Veloso Julio Barraza-Vengoechea Carlos Dueñas Santiago Antonio Juarros Martínez Beatriz Rodríguez-Alonso José-Ángel Martín-Oterino Miguel Montero-Baladia Leticia Moralejo David Andaluz-Ojeda Roberto Gonzalez-Fuentes |
| author_facet | Ivan Cusacovich Álvaro Aparisi Miguel Marcos Cristina Ybarra-Falcón Carolina Iglesias-Echevarria Maria Lopez-Veloso Julio Barraza-Vengoechea Carlos Dueñas Santiago Antonio Juarros Martínez Beatriz Rodríguez-Alonso José-Ángel Martín-Oterino Miguel Montero-Baladia Leticia Moralejo David Andaluz-Ojeda Roberto Gonzalez-Fuentes |
| author_sort | Ivan Cusacovich |
| collection | DOAJ |
| description | Objectives. To assess the influence of corticosteroid pulses on 60-day mortality in hospitalized patients with severe COVID-19. Methods. We designed a multicenter retrospective cohort study in three teaching hospitals of Castilla y León, Spain (865,096 people). We selected patients with confirmed COVID-19 and lung involvement with a pO2/FiO2<300, excluding those exposed to immunosuppressors before or during hospitalization, patients terminally ill at admission, or those who died in the first 24 hours. We performed a propensity score matching (PSM) adjusting covariates that modify the probability of being treated. Then, we used a Cox regression model in the PSM group to consider factors affecting mortality. Results. From 2933 patients, 257 fulfilled the inclusion and exclusion criteria. 124 patients were on corticosteroid pulses (250 mg of methylprednisolone for three days), and 133 were not. 30.3% (37/122) of patients died in the corticosteroid pulse group and 42.9% (57/133) in the nonexposed cohort. These differences (12.6%, 95% CI [8·54-16.65]) were statically significant (log-rank 4.72, p=0,03). We performed PSM using the exact method. Mortality differences remained in the PSM group (log-rank 5.31, p=0.021) and were still significant after a Cox regression model (HR for corticosteroid pulses 0.561; p=0.039). Conclusions. This study provides evidence about treatment with corticosteroid pulses in severe COVID-19 that might significantly reduce mortality. Strict inclusion and exclusion criteria with that selection process set a reliable frame to compare mortality in both the exposed and nonexposed groups. |
| format | Article |
| id | doaj-art-f105b562c4cf4668928889e015e27dc4 |
| institution | Kabale University |
| issn | 0962-9351 1466-1861 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Mediators of Inflammation |
| spelling | doaj-art-f105b562c4cf4668928889e015e27dc42025-02-03T01:00:41ZengWileyMediators of Inflammation0962-93511466-18612021-01-01202110.1155/2021/66372276637227Corticosteroid Pulses for Hospitalized Patients with COVID-19: Effects on MortalityIvan Cusacovich0Álvaro Aparisi1Miguel Marcos2Cristina Ybarra-Falcón3Carolina Iglesias-Echevarria4Maria Lopez-Veloso5Julio Barraza-Vengoechea6Carlos Dueñas7Santiago Antonio Juarros Martínez8Beatriz Rodríguez-Alonso9José-Ángel Martín-Oterino10Miguel Montero-Baladia11Leticia Moralejo12David Andaluz-Ojeda13Roberto Gonzalez-Fuentes14Internal Medicine Department, Hospital Clínico Universitario de Valladolid, SpainCardiology Department, Hospital Clínico Universitario, Valladolid, SpainInternal Medicine Department, Hospital Universitario de Salamanca-IBSAL-Universidad de Salamanca, SpainCardiology Department, Hospital Clínico Universitario, Valladolid, SpainCardiology Department, Hospital Clínico Universitario, Valladolid, SpainInternal Medicine Department, Hospital Universitario de Burgos, SpainInternal Medicine Department, Hospital Universitario de Burgos, SpainInternal Medicine Department, Hospital Clínico Universitario de Valladolid, SpainPulmonology Department, Hospital Clínico Universitario de Valladolid, SpainInternal Medicine Department, Hospital Universitario de Salamanca-IBSAL-Universidad de Salamanca, SpainInternal Medicine Department, Hospital Universitario de Salamanca-IBSAL-Universidad de Salamanca, SpainIntensive Care Unit Department, Hospital Universitario de Burgos, SpainInternal Medicine Department, Hospital Universitario de Salamanca-IBSAL-Universidad de Salamanca, SpainIntensive Care Unit Department, Hospital Clínico Universitario de Valladolid, SpainInternal Medicine Department, Hospital Clínico Universitario de Valladolid, SpainObjectives. To assess the influence of corticosteroid pulses on 60-day mortality in hospitalized patients with severe COVID-19. Methods. We designed a multicenter retrospective cohort study in three teaching hospitals of Castilla y León, Spain (865,096 people). We selected patients with confirmed COVID-19 and lung involvement with a pO2/FiO2<300, excluding those exposed to immunosuppressors before or during hospitalization, patients terminally ill at admission, or those who died in the first 24 hours. We performed a propensity score matching (PSM) adjusting covariates that modify the probability of being treated. Then, we used a Cox regression model in the PSM group to consider factors affecting mortality. Results. From 2933 patients, 257 fulfilled the inclusion and exclusion criteria. 124 patients were on corticosteroid pulses (250 mg of methylprednisolone for three days), and 133 were not. 30.3% (37/122) of patients died in the corticosteroid pulse group and 42.9% (57/133) in the nonexposed cohort. These differences (12.6%, 95% CI [8·54-16.65]) were statically significant (log-rank 4.72, p=0,03). We performed PSM using the exact method. Mortality differences remained in the PSM group (log-rank 5.31, p=0.021) and were still significant after a Cox regression model (HR for corticosteroid pulses 0.561; p=0.039). Conclusions. This study provides evidence about treatment with corticosteroid pulses in severe COVID-19 that might significantly reduce mortality. Strict inclusion and exclusion criteria with that selection process set a reliable frame to compare mortality in both the exposed and nonexposed groups.http://dx.doi.org/10.1155/2021/6637227 |
| spellingShingle | Ivan Cusacovich Álvaro Aparisi Miguel Marcos Cristina Ybarra-Falcón Carolina Iglesias-Echevarria Maria Lopez-Veloso Julio Barraza-Vengoechea Carlos Dueñas Santiago Antonio Juarros Martínez Beatriz Rodríguez-Alonso José-Ángel Martín-Oterino Miguel Montero-Baladia Leticia Moralejo David Andaluz-Ojeda Roberto Gonzalez-Fuentes Corticosteroid Pulses for Hospitalized Patients with COVID-19: Effects on Mortality Mediators of Inflammation |
| title | Corticosteroid Pulses for Hospitalized Patients with COVID-19: Effects on Mortality |
| title_full | Corticosteroid Pulses for Hospitalized Patients with COVID-19: Effects on Mortality |
| title_fullStr | Corticosteroid Pulses for Hospitalized Patients with COVID-19: Effects on Mortality |
| title_full_unstemmed | Corticosteroid Pulses for Hospitalized Patients with COVID-19: Effects on Mortality |
| title_short | Corticosteroid Pulses for Hospitalized Patients with COVID-19: Effects on Mortality |
| title_sort | corticosteroid pulses for hospitalized patients with covid 19 effects on mortality |
| url | http://dx.doi.org/10.1155/2021/6637227 |
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