ABSTRACT
This study aimed to demonstrate the association between high-dose corticosteroid administration and adverse outcomes in coronavirus disease 2019 patients. Data were collected retrospectively from medical records. The primary outcome was invasive mechanical ventilation or death, whichever occurred first. The secondary outcome was all-cause in-hospital mortality. The standard dose was defined as a daily dose of <=1.5 mg/kg of prednisolone or equivalent, and the high-dose was defined as >=250 mg of prednisolone or equivalent. Data were analyzed using frequentist and Bayesian logistic models. In addition, a propensity score-matched subgroup was analyzed for the association between high-dose corticosteroid use and adverse outcomes. A total of 1072 patients hospitalized between September 29, 2020, and April 20, 2021, were enrolled in the study. Of these, 188 patients (18%) had a primary outcome;55 patients (29%) died, and 133 (71%) required invasive mechanical ventilation. Higher age was associated with adverse outcomes in all analyses. Standard dose corticosteroid use was found to be protective (odds ratio [95% confidence interval], 0.53 [0.35-0.81]) in the final logistic model. Point estimates in the propensity score-matched subgroup did not encourage high-dose corticosteroid use (odds ratio [95% confidence interval], 3.06 [0.98-9.50]). The posterior probability density distributions generated by the Bayesian logistic model implicated standard-dose corticosteroid use as protective (80% credible intervals, -0.839 to -0.313), whereas it implicated high-dose corticosteroid use as associated with adverse outcomes (80% credible intervals, 0.163-0.941). This study found high-dose corticosteroid (>=250 mg prednisolone daily) use associated with adverse outcomes. Copyright © Wolters Kluwer Health, Inc. All rights reserved.
ABSTRACT
Background and Aim: A new infectious outbreak sustained by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now spreading all around the world. The aim of this study was to evaluate the prognostic value of left ventricular global longitudinal strain (LV-GLS) and right ventricular longitudinal strain (RV-LS) in patients with coronavirus disease 2019 (COVID-19). Methods: In this prospective, single-center study, data were gathered from patients treated for COVID-19 between April 15 and April 30, 2020. Two-dimensional echocardiography (2-DE) and speckle tracking echocardiography (STE) images were obtained for all patients. Patients were divided into three groups: those with severe COVID-19 infection, those with non-severe COVID-19 infection, and those without COVID-19 infection (the control group). Data regarding clinical characteristics and laboratory findings were obtained from electronic medical records. The primary endpoint was in-hospital mortality. Results: A total of 100 patients hospitalized for COVID-19 were included in this study. The mean age of the severe group (n=44) was 59.1±12.9, 40% of whom were male. The mean age of the non-severe group (n=56) was 53.7±15.1, 58% of whom were male. Of these patients, 22 died in the hospital. In patients in the severe group, LV-GLS and RV-LS were decreased compared to patients in the non-severe and control groups (LVGLS: -14.5±1.8 vs. -16.7±1.3 vs. -19.4±1.6, respectively [p<0.001];RV-LS: -17.2±2.3 vs. -20.5±3.2 vs. -27.3±3.1, respectively [p<0.001]). The presence of cardiac injury, D-dimer, arterial oxygen saturation (SaO2), LV-GLS (OR:1.63, 95% confidence interval [CI] 1.08-2.47;p=0.010) and RV-LS (OR:1.55, 95% CI 1.07-2.25;p=0.019) were identified as independent predictors of mortality via multivariate analysis. Conclusions: LV-GLS and RV-LS are independent predictors of in-hospital mortality in patients with COVID-19.