tetano
Editor, Senior Moderator
Acute Crit Care
. 2023 Feb;38(1):57-67.
doi: 10.4266/acc.2022.00941. Epub 2023 Feb 7.
Methylprednisolone pulse therapy for critically ill patients with COVID-19: a cohort study
Keum-Ju Choi[SUP] 1 [/SUP], Soo Kyun Jung[SUP] 1 [/SUP], Kyung Chan Kim[SUP] 1 [/SUP], Eun Jin Kim[SUP] 1 [/SUP]
Affiliations
Abstract
Background: The guidelines recommend the use of dexamethasone 6 mg or an equivalent dose in patients with coronavirus disease 2019 (COVID-19) who require supplemental oxygen. Given that the severity of COVID-19 varies, we investigated the effect of a pulse dose of corticosteroids on the clinical course of critically ill patients with COVID-19.
Methods: This single-center, retrospective cohort study was conducted between September and December 2021, which was when the Delta variant of the COVID-19 virus was predominant. We evaluated the mortality and oxygenation of severe to critical COVID-19 cases between groups that received dexamethasone 6 mg for 10 days (control group) and methylprednisolone 250 mg/day for 3 days (pulse group).
Results: Among 44 patients, 14 and 30 patients were treated with control steroids and pulse steroids, respectively. There was no difference in disease severity, time from COVID-19 diagnosis to steroid administration, or use of remdesivir or antibacterial agents between the two groups. The pulse steroid group showed a significant improvement in oxygenation before and after steroid treatment (P<0.001) compared with the control steroid group (P=0.196). There was no difference in in-hospital mortality (P=0.186); however, the pulse steroid group had a lower mortality rate (23.3%) than the control steroid group (42.9%). There was a significant difference in the length of hospital stay between both two groups (P=0.039).
Conclusions: Pulse steroids showed no mortality benefit but were associated with oxygenation improvement and shorter hospital stay than control steroids. Hyperglycemia should be carefully monitored with pulse steroids.
Keywords: COVID-19; dexamethasone; drug pulse therapy; methylprednisolone; steroid.
. 2023 Feb;38(1):57-67.
doi: 10.4266/acc.2022.00941. Epub 2023 Feb 7.
Methylprednisolone pulse therapy for critically ill patients with COVID-19: a cohort study
Keum-Ju Choi[SUP] 1 [/SUP], Soo Kyun Jung[SUP] 1 [/SUP], Kyung Chan Kim[SUP] 1 [/SUP], Eun Jin Kim[SUP] 1 [/SUP]
Affiliations
- PMID: 36935535
- DOI: 10.4266/acc.2022.00941
Abstract
Background: The guidelines recommend the use of dexamethasone 6 mg or an equivalent dose in patients with coronavirus disease 2019 (COVID-19) who require supplemental oxygen. Given that the severity of COVID-19 varies, we investigated the effect of a pulse dose of corticosteroids on the clinical course of critically ill patients with COVID-19.
Methods: This single-center, retrospective cohort study was conducted between September and December 2021, which was when the Delta variant of the COVID-19 virus was predominant. We evaluated the mortality and oxygenation of severe to critical COVID-19 cases between groups that received dexamethasone 6 mg for 10 days (control group) and methylprednisolone 250 mg/day for 3 days (pulse group).
Results: Among 44 patients, 14 and 30 patients were treated with control steroids and pulse steroids, respectively. There was no difference in disease severity, time from COVID-19 diagnosis to steroid administration, or use of remdesivir or antibacterial agents between the two groups. The pulse steroid group showed a significant improvement in oxygenation before and after steroid treatment (P<0.001) compared with the control steroid group (P=0.196). There was no difference in in-hospital mortality (P=0.186); however, the pulse steroid group had a lower mortality rate (23.3%) than the control steroid group (42.9%). There was a significant difference in the length of hospital stay between both two groups (P=0.039).
Conclusions: Pulse steroids showed no mortality benefit but were associated with oxygenation improvement and shorter hospital stay than control steroids. Hyperglycemia should be carefully monitored with pulse steroids.
Keywords: COVID-19; dexamethasone; drug pulse therapy; methylprednisolone; steroid.