tetano
Editor, Senior Moderator
Clin Microbiol Infect
. 2020 Sep 21;S1198-743X(20)30563-2.
doi: 10.1016/j.cmi.2020.09.014. Online ahead of print.
Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicenter study
Michele Bartoletti[SUP] 1 [/SUP], Lorenzo Marconi[SUP] 2 [/SUP], Luigia Scudeller[SUP] 3 [/SUP], Livia Pancaldi[SUP] 4 [/SUP], Sara Tedeschi[SUP] 4 [/SUP], Maddalena Giannella[SUP] 4 [/SUP], Matteo Rinaldi[SUP] 4 [/SUP], Linda Bussini[SUP] 4 [/SUP], Ilaria Valentini[SUP] 5 [/SUP], Anna Filomena Ferravante[SUP] 5 [/SUP], Antonella Potalivo[SUP] 6 [/SUP], Elisa Marchionni[SUP] 2 [/SUP], Giacomo Fornaro[SUP] 4 [/SUP], Renato Pascale[SUP] 4 [/SUP], Zeno Pasquini[SUP] 7 [/SUP], Massimo Puoti[SUP] 8 [/SUP], Marco Merli[SUP] 8 [/SUP], Francesco Barchiesi[SUP] 7 [/SUP], Francesca Volpato[SUP] 4 [/SUP], Arianna Rubin[SUP] 4 [/SUP], Annalisa Saracino[SUP] 9 [/SUP], Tommaso Tonetti[SUP] 10 [/SUP], Paolo Gaibani[SUP] 11 [/SUP], Vito Marco Ranieri[SUP] 10 [/SUP], Pierluigi Viale[SUP] 4 [/SUP], Francesco Cristini[SUP] 2 [/SUP], PREDICO study group
Collaborators, Affiliations
Abstract
Objectives: To assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19) METHODS: Multicenter observational study from February 22 through June 30, 2020. We included consecutive adult patients with severe COVID-19 defined as respiratory rate ≥30 breath per minute, oxygen saturation ≤93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ≤300 mmHg. We excluded patients treated with other immunomodulant drugs, receiving low dose of corticosteroids and those receiving corticosteroids after 72h from admission. The primary endpoint was 30-day mortality form hospital admission. The main exposure variable was corticosteroid therapy at dosage of ≥0.5 mg/kg of prednisone equivalents. It was introduced as binomial covariate in a logistic regression model for primary endpoint and inverse probability of treatment weighting using the propensity score.
Results: Of 1717 patients with COVID-19 evaluated, 513 patients were included in the study; of these 170 (33%) were treated with corticosteroids. During the hospitalization 166 (34%) patients reached the primary outcome [60/170 (35%) in the corticosteroid group and 106/343 (31%) in the non-corticosteroid group]. At multivariable analysis corticosteroid treatment was not associated with lower 30-day mortality rate [aOR 0.59 (0.20-1.74), p=0.33]. After inverse probability of treatment weighting, corticosteroids were not associated to lower 30-day mortality [average treatment effect 0.05 (95% -0.02 to 0.09), p=0.12]. However, subgroup analysis revealed that in patients with PO[SUB]2[/SUB]/FiO[SUB]2[/SUB] < 200 mmHg at admission [135 patients, 52 (38%) treated with corticosteroids] corticosteroid treatment was associated to a lower risk of 30-day mortality [23/52 (44%) vs 45/83 (54%), aOR 0.20 (95%CI 0.04 to 0.90), p=0.036].
Conclusion: Our study shows that the effect of corticosteroid treatment on mortality might be limited to critically ill COVID-19 patients.
Keywords: ARDS; COVID-19; SARS-CoV-2; corticosteroids; mortality.
. 2020 Sep 21;S1198-743X(20)30563-2.
doi: 10.1016/j.cmi.2020.09.014. Online ahead of print.
Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicenter study
Michele Bartoletti[SUP] 1 [/SUP], Lorenzo Marconi[SUP] 2 [/SUP], Luigia Scudeller[SUP] 3 [/SUP], Livia Pancaldi[SUP] 4 [/SUP], Sara Tedeschi[SUP] 4 [/SUP], Maddalena Giannella[SUP] 4 [/SUP], Matteo Rinaldi[SUP] 4 [/SUP], Linda Bussini[SUP] 4 [/SUP], Ilaria Valentini[SUP] 5 [/SUP], Anna Filomena Ferravante[SUP] 5 [/SUP], Antonella Potalivo[SUP] 6 [/SUP], Elisa Marchionni[SUP] 2 [/SUP], Giacomo Fornaro[SUP] 4 [/SUP], Renato Pascale[SUP] 4 [/SUP], Zeno Pasquini[SUP] 7 [/SUP], Massimo Puoti[SUP] 8 [/SUP], Marco Merli[SUP] 8 [/SUP], Francesco Barchiesi[SUP] 7 [/SUP], Francesca Volpato[SUP] 4 [/SUP], Arianna Rubin[SUP] 4 [/SUP], Annalisa Saracino[SUP] 9 [/SUP], Tommaso Tonetti[SUP] 10 [/SUP], Paolo Gaibani[SUP] 11 [/SUP], Vito Marco Ranieri[SUP] 10 [/SUP], Pierluigi Viale[SUP] 4 [/SUP], Francesco Cristini[SUP] 2 [/SUP], PREDICO study group
Collaborators, Affiliations
- PMID: 32971254
- DOI: 10.1016/j.cmi.2020.09.014
Abstract
Objectives: To assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19) METHODS: Multicenter observational study from February 22 through June 30, 2020. We included consecutive adult patients with severe COVID-19 defined as respiratory rate ≥30 breath per minute, oxygen saturation ≤93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ≤300 mmHg. We excluded patients treated with other immunomodulant drugs, receiving low dose of corticosteroids and those receiving corticosteroids after 72h from admission. The primary endpoint was 30-day mortality form hospital admission. The main exposure variable was corticosteroid therapy at dosage of ≥0.5 mg/kg of prednisone equivalents. It was introduced as binomial covariate in a logistic regression model for primary endpoint and inverse probability of treatment weighting using the propensity score.
Results: Of 1717 patients with COVID-19 evaluated, 513 patients were included in the study; of these 170 (33%) were treated with corticosteroids. During the hospitalization 166 (34%) patients reached the primary outcome [60/170 (35%) in the corticosteroid group and 106/343 (31%) in the non-corticosteroid group]. At multivariable analysis corticosteroid treatment was not associated with lower 30-day mortality rate [aOR 0.59 (0.20-1.74), p=0.33]. After inverse probability of treatment weighting, corticosteroids were not associated to lower 30-day mortality [average treatment effect 0.05 (95% -0.02 to 0.09), p=0.12]. However, subgroup analysis revealed that in patients with PO[SUB]2[/SUB]/FiO[SUB]2[/SUB] < 200 mmHg at admission [135 patients, 52 (38%) treated with corticosteroids] corticosteroid treatment was associated to a lower risk of 30-day mortality [23/52 (44%) vs 45/83 (54%), aOR 0.20 (95%CI 0.04 to 0.90), p=0.036].
Conclusion: Our study shows that the effect of corticosteroid treatment on mortality might be limited to critically ill COVID-19 patients.
Keywords: ARDS; COVID-19; SARS-CoV-2; corticosteroids; mortality.