Do high-dose corticosteroids improve outcomes in hospitalized COVID-19 patients?

Coronavirus disease 2019 (COVID-19) is characterized by dysregulated hyperimmune response and steroids have been shown to decrease mortality. However, whether higher dosing of steroids results in better outcomes has been debated. This was a retrospective observation of COVID-19 admissions between March 1, 2020, and March 10, 2021. Adult patients (≥18 years) who received more than 10 mg daily methylprednisolone equivalent dosing (MED) within the first 14 days were included. We excluded patients who were discharged or died within 7 days of admission. We compared the standard dose of steroids (<40 mg MED) versus the high dose of steroids (>40 mg MED). Inverse probability weighted regression adjustment (IPWRA) was used to examine whether higher dose steroids resulted in improved outcomes. The outcomes studied were in-hospital mortality, rate of acute kidney injury (AKI) requiring hemodialysis, invasive mechanical ventilation (IMV), hospital-associated infections (HAI), and readmissions. Of the 1379 patients meeting study criteria, 506 received less than 40 mg of MED (median dose 30 mg MED) and 873 received more than or equal to 40 mg of MED (median dose 78 mg MED). Unadjusted in-hospital mortality was higher in patients who received high-dose corticosteroids (40.7% vs. 18.6%, p < 0.001). On IPWRA, the use of high-dose corticosteroids was associated with higher odds of death (odds ratio [OR] 2.14; 95% confidence interval [CI] 1.45-3.14, p < 0.001) but not with the development of HAI, readmissions, or requirement of IMV. High-dose corticosteroids were associated with lower rates of AKI requiring hemodialysis (OR 0.33; 95% CI 0.18-0.63). In COVID-19, corticosteroids more than or equal to 40 mg MED were associated with higher in-hospital mortality.

Does ABO Blood Groups Affect Outcomes in Hospitalized COVID-19 Patients?

BACKGROUND: Blood group type A has been associated with increased susceptibility for coronavirus disease 2019 (COVID-19) infection when compared to group O. The aim of our study was to examine outcomes in hospitalized COVID-19 patients among blood groups A and O. METHODS: This is an observational study. Kruskal-Wallis and Chi-square tests were used to compare continuous and categorical variables. Multivariable logistic regression models were used to examine association of blood groups with rates of mortality and severity of disease. All adult patients (> 18 years) admitted with COVID-19 infection between March 1, 2020 and March 10, 2021 at a large community hospital in Northeast Georgia were included. We compared mortality, severity of disease (use of mechanical ventilation, vasopressor, and acute renal failure), rates of venous thromboembolism and inflammatory markers between the blood groups. We used multivariable logistic regression model to adjust for demographical and clinical characteristics, use of COVID-19 medications and severity. RESULTS: A total of 3,563 of 5,204 admitted patients had information on blood groups. Of these, 1,301 (36.5%) were group A, 377 (10.6 %) were group B, 133 (3.7%) were group AB and 1,752 (49.2%) were group O. On adjusted analysis, there were no significant differences in rates of intensive care unit (ICU) admissions, mechanical ventilation, vasopressors, acute renal failure, venous thromboembolism and readmission rate between the blood groups A and O. In-hospital mortality was also not statistically different among the blood groups A and O (17.5% vs. 20.1%; P = 0.07). On adjusted analysis, in-hospital mortality was not lower in blood groups O (odds ratio (OR): 1.06; 95% confidence interval (CI): 0.80 - 1.40, P = 0.70). CONCLUSIONS: Once hospitalized with COVID-19 infection, blood groups A and O are not associated with increased severity or in-hospital mortality.

Predictors and outcomes of healthcare-associated infections in COVID-19 patients.

INTRODUCTION: Healthcare-associated infections (HAI) after viral illnesses are important sources of morbidity and mortality. This has not been extensively studied in hospitalized COVID-19 patients. METHODS: This study included all COVID-19-positive adult patients (≥18 years) hospitalized between 01 March and 05 August 2020 at the current institution. The Centers for Disease Control and Prevention definition of HAI in the acute care setting was used. The outcomes that were studied were rates and types of infections and in-hospital mortality. Several multivariable logistic regression models were constructed to examine characteristics associated with development of HAI. RESULTS: Fifty-nine (3.7%) of 1565 patients developed 140 separate HAIs from 73 different organisms: 23 were Gram-positive, 39 were Gram-negative and 11 were fungal. Patients who developed HAI did not have higher odds of death (OR 0.85, 95% CI 0.40-1.81, p = 0.69). HAIs were associated with the use of tocilizumab (OR 5.04, 95% CI 2.4-10.6, p < 0.001), steroids (OR 3.8, 95% CI 1.4-10, p = 0.007), hydroxychloroquine (OR 3.0, 95% CI 1.0-8.8, p = 0.05), and acute kidney injury requiring hemodialysis (OR 3.7, 95% CI 1.1-12.8, p = 0.04). CONCLUSIONS: HAI were common in hospitalized Covid-19 patients. Tocilizumab and steroids were associated with increased risk of HAIs.