ABSTRACT
We aimed to determine the impact of steroid use in COVID-19 in-hospital mortality, in a retrospective cohort study of the SEMICOVID19 database of admitted patients with SARS-CoV-2 laboratory-confirmed pneumonia from 131 Spanish hospitals. Patients treated with corticosteroids were compared to patients not treated with corticosteroids; and adjusted using a propensity-score for steroid treatment. From March-July 2020, 5.262 (35.26%) were treated with corticosteroids and 9.659 (64.73%) were not. In-hospital mortality overall was 20.50%; it was higher in patients treated with corticosteroids than in controls (28.5% versus 16.2%, OR 2.068 [95% confidence interval; 1.908 to 2.242]; p = 0.0001); however, when adjusting by occurrence of ARDS, mortality was significantly lower in the steroid group (43.4% versus 57.6%; OR 0.564 [95% confidence interval; 0.503 to 0.633]; p = 0.0001). Moreover, the greater the respiratory failure, the greater the impact on mortality of the steroid treatment. When adjusting these results including the propensity score as a covariate, in-hospital mortality remained significantly lower in the steroid group (OR 0.774 [0.660 to 0.907], p = 0.002). Steroid treatment reduced mortality by 24% relative to no steroid treatment (RRR 0.24). These results support the use of glucocorticoids in COVID-19 in this subgroup of patients.
Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Internal Medicine/methods , Pneumonia, Viral/epidemiology , Telemedicine , COVID-19 , Delivery of Health Care/organization & administration , Humans , Internal Medicine/trends , Pandemics , Physical Examination , SARS-CoV-2 , TelepathyABSTRACT
INTRODUCTION: The COVID-19 pandemic has brought about a paradigm shift in healthcare. OBJECTIVE: To evaluate the utility of a strategy to comprehensively address the pandemic in a health area that covers 42,000 people. METHOD: Between March 10 and May 15, 2020, the COVID Unit was created in the corresponding regional hospital, and an independent circuit was established for the diagnosis and management of patients with suspected or confirmed COVID-19; social health centers were monitored with PCR testing. RESULTS: Eighteen COVID-19-positive patients (age 72.9 ± 13.2 years) were admitted, out of which 66% were males. All these patients had pneumonia and 67% had respiratory distress syndrome; no one required mechanical ventilation. Mean hospital stay was 9.4 ± 5.3 days, and mortality, 11%. PCR tests were applied to all hospital residents (n = 827) and workers (n = 519), 1,044 phone calls were made and 36 hospital admissions were avoided. Only 50 patients required close follow-up, out of which four (0.48%) were positive for COVID-19. CONCLUSION: Clinical monitoring at the hospital and social health centers showed that patient profile was like that documented in the literature and that the incidence of COVID-19 was low in social health centers.
INTRODUCCIÓN: La pandemia de COVID-19 provocó un cambio de paradigma en la atención médica. OBJETIVO: Evaluar una estrategia para abordar integralmente la pandemia en un distrito de salud que comprende 42 000 personas. MÉTODO: Entre el 10 de marzo y 15 de mayo de 2020 se creó la Unidad COVID en un hospital regional correspondiente al distrito y se estableció un circuito independiente para el diagnóstico y manejo de pacientes con sospecha o confirmación de COVID-19; los centros de salud social fueron monitoreados mediante PCR. RESULTADOS: Ingresaron 18 pacientes positivos a COVID-19 (edad de 72.9 ± 13.2 años), 66 % eran hombres; todos presentaron neumonía, 67 % desarrolló síndrome de dificultad respiratoria y ninguno requirió ventilación mecánica. La estancia hospitalaria fue de 9.4 ± 5.3 días y la mortalidad, de 11 %. Se realizaron pruebas de PCR a todos los residentes (n = 827) y trabajadores (n = 519) del hospital, se realizaron 1044 llamadas telefónicas y se evitaron 36 hospitalizaciones. Solo 50 pacientes necesitaron seguimiento cercano, cuatro (0.48 %) positivos a COVID-19. CONCLUSIÓN: El monitoreo clínico en el hospital y centros de salud social mostró que el perfil de los pacientes fue similar al documentado en la literatura y que la incidencia de COVID-19 fue baja en los centros sociales de salud.