tetano
Editor, Senior Moderator
Clin Infect Dis
. 2020 Aug 9;ciaa1163.
doi: 10.1093/cid/ciaa1163. Online ahead of print.
Clinical Outcomes Associated with Methylprednisolone in Mechanically Ventilated Patients with COVID-19
Brian C Nelson[SUP] 1 [/SUP], Justin Laracy[SUP] 2 [/SUP], Sherif Shoucri[SUP] 2 [/SUP], Donald Dietz[SUP] 2 [/SUP], Jason Zucker[SUP] 2 [/SUP], Nina Patel[SUP] 3 [/SUP], Magdalena E Sobieszczyk[SUP] 2 [/SUP], Christine J Kubin[SUP] 1 [/SUP], Angela Gomez-Simmonds[SUP] 2 [/SUP]
Affiliations
Abstract
Background: The efficacy and safety of methylprednisolone in mechanically ventilated patients with acute respiratory distress syndrome due to coronavirus disease 2019 (COVID-19) are unclear. In this study, we evaluated the association between use of methylprednisolone and key clinical outcomes.
Methods: Clinical outcomes associated with the use of methylprednisolone were assessed in an unmatched, case-control study; a subset of patients also underwent propensity-score matching. Patients were admitted between March 1 and April 12, 2020. The primary outcome was ventilator-free days by 28 days after admission. Secondary outcomes included extubation, mortality, discharge, positive cultures, and hyperglycemia.
Results: A total of 117 patients met inclusion criteria. Propensity matching yielded a cohort of 42 well-matched pairs. Groups were similar except for hydroxychloroquine and azithromycin use, which were more common in patients who did not receive methylprednisolone. Mean ventilator free-days were significantly higher in patients treated with methylprednisolone (6.21?7.45 versus 3.14?6.22; P = 0.044). The probability of extubation was also increased in patients receiving methylprednisolone (45% versus 21%; P = 0.021), and there were no significant differences in mortality (19% versus 36%; P = 0.087). In a multivariable linear regression analysis, only methylprednisolone use was associated with higher number of ventilator-free days (P = 0.045). The incidence of positive cultures and hyperglycemia were similar between groups.
Conclusions: Methylprednisolone was associated with increased ventilator-free days and higher probability of extubation in a propensity-score matched cohort. Randomized, controlled studies are needed to further define methylprednisolone use in patients with COVID-19.
Keywords: COVID-19; SARS-CoV-2; intubated; methylprednisolone.
. 2020 Aug 9;ciaa1163.
doi: 10.1093/cid/ciaa1163. Online ahead of print.
Clinical Outcomes Associated with Methylprednisolone in Mechanically Ventilated Patients with COVID-19
Brian C Nelson[SUP] 1 [/SUP], Justin Laracy[SUP] 2 [/SUP], Sherif Shoucri[SUP] 2 [/SUP], Donald Dietz[SUP] 2 [/SUP], Jason Zucker[SUP] 2 [/SUP], Nina Patel[SUP] 3 [/SUP], Magdalena E Sobieszczyk[SUP] 2 [/SUP], Christine J Kubin[SUP] 1 [/SUP], Angela Gomez-Simmonds[SUP] 2 [/SUP]
Affiliations
- PMID: 32772069
- DOI: 10.1093/cid/ciaa1163
Abstract
Background: The efficacy and safety of methylprednisolone in mechanically ventilated patients with acute respiratory distress syndrome due to coronavirus disease 2019 (COVID-19) are unclear. In this study, we evaluated the association between use of methylprednisolone and key clinical outcomes.
Methods: Clinical outcomes associated with the use of methylprednisolone were assessed in an unmatched, case-control study; a subset of patients also underwent propensity-score matching. Patients were admitted between March 1 and April 12, 2020. The primary outcome was ventilator-free days by 28 days after admission. Secondary outcomes included extubation, mortality, discharge, positive cultures, and hyperglycemia.
Results: A total of 117 patients met inclusion criteria. Propensity matching yielded a cohort of 42 well-matched pairs. Groups were similar except for hydroxychloroquine and azithromycin use, which were more common in patients who did not receive methylprednisolone. Mean ventilator free-days were significantly higher in patients treated with methylprednisolone (6.21?7.45 versus 3.14?6.22; P = 0.044). The probability of extubation was also increased in patients receiving methylprednisolone (45% versus 21%; P = 0.021), and there were no significant differences in mortality (19% versus 36%; P = 0.087). In a multivariable linear regression analysis, only methylprednisolone use was associated with higher number of ventilator-free days (P = 0.045). The incidence of positive cultures and hyperglycemia were similar between groups.
Conclusions: Methylprednisolone was associated with increased ventilator-free days and higher probability of extubation in a propensity-score matched cohort. Randomized, controlled studies are needed to further define methylprednisolone use in patients with COVID-19.
Keywords: COVID-19; SARS-CoV-2; intubated; methylprednisolone.