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Asthma and COPD comorbidities are expected to exacerbate the clinical manifestations of COVID-19. However, many reported studies show that asthmatic patients infected with COVID-19 do not show severe clinical manifestations, and some are asymptomatic. This literature review aimed to describe COVID-19 in asthmatic patients along with the hypothesis that asthma is a protective factor against COVID-19 infection. Systemic corticosteroids have been shown to reduce the death/mortality rate in patients who are hospitalized due to COVID-19 infection. This is possibly due to the suppression of the immune system against a hyperinflammatory state which can result in further damage from SARS-CoV-2 infection. Mucus hypersecretion, which is one of the hallmarks of asthma, can prevent the SARS-CoV-2 virus from reaching the distal lung and can protect the lungs from pathological processes. The secreted mucus is rich in glycoproteins, such as MUC5AC, which act as the first line of defense against infection. Mucus hypersecretion in asthmatic patients may prevent SARS-CoV-2 from penetrating far enough to gain access to type-2 alveolar cells, which are the cells that predominantly express ACE2 in the lungs. In conclusion, comorbid asthma in patients infected with COVID-19 does not cause adverse clinical manifestations to appear, but on the contrary, it will have a protective effect on patients.
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Background and Objective: At the beginning of the pandemic, Hydroxychloroquine (HCQ) was one of the most widely used drugs prescribed to patients admitted to hospitals with coronavirus disease 2019 (COVID-19). We try to find the effect of HCQ on the severity and mortality of patients who did not receive corticosteroids. Methods: In this retrospective study, patients with COVID-19 disease were collected from February 20, 2020, to July 21, 2020, at Rouhani Hospital in Babol. Patients were followed up until December 6, 2021. In this study, 170 patients in case and control groups were studied. We used logistic and COX regression models to explore the effects of drugs. Data were analyzed by SPSS version 22. Findings: The use of HCQ did not affect mortality (p=0.46, 95%CI= 0.63 to 2.71, OR= 1.31) and final severity (p= 0.75, 95%CI= 0.59 to 2.06, OR= 1.10) at admission time. However, azithromycin remained in the final model but did not have a significant effect (P= 0.08, HR= 0.28, 95%CI= 0.06 to 0.18). Heparin use was not associated with severity improvement (p= 0.06, 95%CI= 0.97 to 2.81, HR= 1.65), while ceftriaxone remained a factor affecting severity in the model (p = 0.03, 95% CI= 0.29 to 0.95, HR = 0.52). Conclusion: In this study, HCQ harmed mortality admission time and was ineffective in the long term. The use of ceftriaxone compared to other drugs showed protective effects against the mortality hospitalization time. Heparin is not recommended without considering the risk of bleeding in COVID-19 patients.
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The Sars-CoV-2, the virus that causes Covid-19 (coronavirus disease 2019), is highly transmissible and of rapid dissemination, and transmitted by respiratory droplets and by direct contact, which can cause respiratory failure and reach multiple organs. Although there is still no effective treatment for the disease, the use of corticosteroids has shown positive results in patients with severe Covid-19, such as dexamethasone, which acts as an immunosuppressant to control cytokine storm syndrome (CSS). In this review, we will abroad the challenge of establishing a balance between risk and benefit in corticosteroid therapy in severe cases of the disease, since corticosteroids can activate the latent infection by Strongyloides stercoralis and develop the critical form of strongyloidiasis, the Strongyloides stercoralis hyperinflation syndrome (SHS). For these circumstances, screening and empirical treatment with ivermectin is recommended for those patients at moderate to high risk of hyperinfection. The keywords used were "Strongyloides" AND "Covid" and the searched databases were PubMed, Scopus, and Web of Science. The selected articles were published from 2020 to 2021 and without language restriction.Copyright © 2022 Sociedade Brasileira de Pneumologia e Tisiologia. All rights reserved.
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BACKGROUND: Pneumomediastinum is defined as open-air in the mediastinum. Spontaneous pneumomediastinum (SPM) occurs when air leaks into the surrounding vascular sheath through small alveolar ruptures. CASE REPORT: We want to introduce 4 different cases with different outcomes. The first case was a 60-year-old man with a history of psychological disorders, the second case was a 41-year-old man with a history of hypertension (HTN) and asthma, the third case was a 50-year-old heavy smoker with no history of an underlying disease, and the fourth case was a 60-year-old man with a history of schizophrenia. They suddenly developed an exacerbation of cough, dyspnea, chest pain, and a severe decrease in oxygen saturation during hospitalization. Antibiotic therapy, corticosteroids, and high-dose oxygen therapy were administered to the patients. One of these patients died. CONCLUSION: All patients can potentially be at risk for this complication and have a good prognosis if diagnosed early and treated properly overall.
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COVID-19 is associated with disseminated lung damage in patients, Dexamethasone can reduce lung injury caused by inflammation and there reduce the progression to respiratory failure and prevent death. This systematic review aimed to determine the benefits and safety of Dexamethasone in COVID-19 treatment. The study was performed by a comprehensive literature search which were published in several databases i.e., PubMed, Science Direct, VHL Regional Portal, and ClinicalTrials.gov within the search time of 28 November 2020. Inclusion criteria were articles on the study on COVID-19 patients who received Dexamethasone, observational and experimental studies on the outcomes use evaluation of Dexamethasone. Exclusion criteria are the articles that do not provide control in controlled studies and do not show clear research results on the use of Dexamethasone. An initial search from four databases by entering keywords resulted in 1,046 articles. After screening articles duplication we obtained 835 studies. Finally, 6 articles were obtained after we screened for the article that it can be obtained its full text and 5 articles joined in articles included in the meta-analysis. The analysis showed that Dexamethasone in Covid-19 patients could reduce the incidence of death within 28 days with RR of 0.78 (95% CI 0.57-0.97 P=0.13) compared with Methylprednisolone, Dexamethasone was compared without corticosteroids with RR 0.89 (95% CI 0.82-0.97 P=0.01). Dexamethasone also reduced mechanical ventilator use during treatment with RR 0.95 (95% CI = 0.86-1.05 P = 0.28) compared without corticosteroids. The conclusion from these results: the use of Dexamethasone can reduce the number of deaths in COVID-19 patients, especially severe and critically ill category patients.
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Introduction: COVID-19 is a disease that is induced by severe acute respiratory syndrome coronavirus (SARS). Its viral infection is spread swiftly around the world and causes many restrictions, health problems, and expensive treatment costs worldwide. Due to its high prevalence and mortality rate, there is a global challenge to find an effective therapeutic protocol for the prevention and treatment of COVID-19. No one could disclaim the immediate need for a standardized protocol for COVID-19 treatment. Methods: Aiming to prepare a comprehensive review of introducing appropriate remedial options for COVID-19, a wide range of investigation on relevant articles established in the English language published through different publications such as PubMed, Medline, Embase, Science Direct, Scopus, and COVID-Evidence . all researchers and clinicians should try to make more precise knowledge about the viral behavior and treatment of COVID-19 to find an effective vaccine to prevent and treatment of this virus. The main objective of the present study is to review and investigate the available evidence for achieving a more precise preventive and treatment protocol to deal with COVID-19. Findings: many available drugs have been reviewed that include Azithromycin, Lopinavir/ritonavir (LPV/r), Remdesivir, Corticosteroids, Chloroquine, Hydroxychloroquine, Hydroxychloroquine sulfate, Immunoglobulin, Ivermectin, Ribavirin, Favipiravir, Interferon. On the other hand, it is recommended to conduct precise clinical trials on current antimicrobial and antiviral agents that are administered for a long time to find an expeditious and effective response to the COVID-19 pandemic. Although disappointing, it should be noted that there is no effective drug regimen or vaccine against the novel coronavirus. In this regard, using other available antiviral drugs for the treatment of COVID-19 may be effective to some extent. In this study, by investigating some available antimicrobial medicines that may diminish COVID-19 infection, we are trying to introduce a general protocol for controlling this disease.
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Introduction: It has been reported that short-term and lowdose intravenous corticosteroids prevent the progression of the disease and reduce mortality during the hyperinflammation period caused by the virus in COVID-19 disease. The aim of our study is to evaluate the clinical course, hospital readmission and mortality rates of patients with mild to moderate COVID- 19 pneumonia, who do not need oxygen and for whom we started outpatient corticosteroid treatment. Materials and Methods: Patients over the age of 18 who applied to our hospital with the diagnosis of mild-to-moderate COVID-19 pneumonia and were treated with outpatient oral systemic corticosteroid were included in the study. Inclusion criteria were pneumonia finding consistent with mild to moderate COVID-19 involvement in lung computerized tomography, seven days or more from symptom onset, and oxygen saturation of 93 and above. The patients were given dexamethasone 8 milligrams (mg) methylprednisolone 32 mg, methylprednisolone 40 mg as oral systemic corticosteroid. Results: The mean age of the patients was 49.2 +or- 12, and 60% of them were male. The median steroid duration was 6.76 +or- 2.35 days. Due to ongoing symptoms, 56% of the patients were admitted to the hospital again, 12% were hospitalized due to clinical and laboratory deterioration, the intensive care hospitalization rate was 3% and the mortality rate was 2% (2/100). Conclusion: As a result, the effectiveness of oral corticosteroids on mortality and morbidity has not been demonstrated in mild to moderate COVID-19 pneumonia. Well-designed randomized controlled studies are needed on this subject.
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CoronaVirus Disease 2019 (COVID-19) is a viral infection caused by the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2), which is globally influential and has killed more than 6 million patients until today. Hyper-secretion of pro-inflammatory cytokines triggered by the viral infection that cannot be eliminated by the immune system and an ongoing hyper-inflammatory state primarily in the lung seem to be the major causes of death. The mechanisms proposed to explain the pathogenesis of the cytokine storm associated with COVID-19 included poor viral clearance and persistent robust cytokine response despite inadequate antiviral immunity. The diagnosis can be made easily by clinical features, imaging techniques, and nasopharyngeal PCR. The diagnosis of this hyper-inflammatory state in a patient with COVID-19 can be made with rapid deterioration in clinical features, and laboratory findings including abnormally high serum CRP, ferritin and D-dimer levels, and rapidly progressive pulmonary radiological findings. In addition to the anti-viral and supportive treatments, corticosteroids, IL-1, or IL-6 receptor blockers are frequently used to suppress the increased cytokine response.
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Introduction: Now more than ever the pharmacovigilance has demonstrated great relevance in making medication safer by evaluating the benefit-risk ratio in the treatment used in COVID-19 patients [1];nevertheless, pharmacovigilance has always aimed to help clinicians and patients make wiser therapeutical decisions as Dra. Marie Lindquist's once said. Therefore, we have developed at the Instituto Nacional de Cardiología Ignacio Chavez the Pharmacovigilance Institutional Center, establishing as our goals to manage a pharmacovigilance's system that aims to take the World Health Organization Challenge Medication Without Harm by promoting the rational use of medication, and identifying risks related to drugs before they impact the patients. Objective: Exemplify the impact that a clinical focus pharmacovigilance system has had in the patients at the Instituto Nacional de Cardiología Ignacio Chavez. Methods: With the Pharmacovigilance Institutional Center databases of Drug Adverse Reactions (DAR) and Event Supposedly Attributed to Vaccination or Immunization (ESAVI) identify the most important cases in which a clinical decision has been made and exemplify the process of the decision making. Results: From the opening of the Institutional Center in 2020 at the start of the COVID-19 pandemic, we have identified and reported 292 DAR in VigiFlow and 421 ESAVI to the General Direction of Epidemiology. From these reports we can identify several different pharmaceutical interventions related to the pharmacovigilance evaluations, that have given as a result the modification of the clinical approach: * Corticosteroids used in COVID-19 patients: we modified the dosage given to patients reducing the severity of the DAR. * Drug Induced Liver Injury: we alerted in early moment the elevation of hepatic markers making changes in the prescriptions. * * Dapagliflozin use in heart failure patients that produced ketoacidosis: after alerting the surgical team there was no more patients presenting this DAR. * * Tocilizumab used in COVID-19 patients, there was a concern to use this monoclonal medication: with this intervention we established the safety parameters to use this medication. * * RNA COVID-19 vaccines producing myocarditis: with this intervention we have been able to establish a fast identification of these cases. Exemplifying the process in the next table. Conclusion: Pharmacovigilance now a day require to explore a more patient focus and clinical approach in where there are pharmacovigilants working hand by hand next to the clinicians and understanding the needs of the patients. For that we require assemble teams that can identify, evaluate and give feedback on the best way to treat DAR.
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Introduction: Like many countries in the world, the first wave of the COVID-19 (Coronavirus Disease 2019) pandemic in Morocco was marked by an overload of infected patients and unprecedented challenges. This, combined with the unknown nature of the disease, has compelled clinicians to prescribe a wide range of medicines, including experimental drugs as well as symptomatic therapies. These practices were associated with an increase in the incidence of adverse drug events (ADEs), which were reported to be higher in the COVID-19 population [1]. Among front-line health workers, pharmacists were assigned various roles such as active and passive pharmacovigilance in order to ensure the safe use of drugs [2]. This was the case of our hospital, where some pharmacists participate in medical rounds to provide pharmaceutical care near patients. Objective: To demonstrate the importance of a clinical pharmacist in the reporting of ADEs in hospitalized COVID-19 patients. Methods: An observational study was conducted between September 2020 and January 2021 at a university hospital in Rabat. Only one of five COVID-19 units had a pharmacist as a full time member of the medical team. The notification of ADEs are made on a sheet designed by the National Pharmacovigilance Center. After assessing the collected ADE's, the pharmacist compared them to all ADE's that were reported from other COVID-19 units during the study period. Data were subsequently analyzed using Excel. Results: A total of 42 ADEs in 35 patients were notified by the pharmacist (population size = 120). Experimental drugs used for the viral treatment (hydroxychloroquine and azithromycin) were the most commonly recorded medications with ADEs (30%), 27% were anti-coagulants and 13,5% were corticosteroids. Regarding ADEs, 26% consisted of QT interval prolongation, followed by hyperkalemia (26%), hyperglycemia (19%), bleeding (7%), and hepatic cytolysis (5%). In comparison, only 3 ADEs were notified from other COVID-19 units of the hospital. Conclusion: Results of our study suggests that the presence of a pharmacist in a multidisciplinary team is crucial to enhance patient care and safety, particularly in these times of crisis. Our study has also shed light on the poor reporting rate of ADEs in the hospitalized patients, which was previously mentioned to be common in the developing world [3]. Strategies to improve the pharmacovigilance system in Morocco are needed to better prepare healthcare structures for future epidemics.
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During the COVID-19 pandemic, doctors faced an unprecedented mass admission of patients with viral atypical pneumonia. The objective of the study was to compare the clinical characteristics of the first and second waves of the pandemic. An analytical observational study was carried out on patients with COVID-19 pneumonia who were admitted to Hospital Carrion de Huancayo, Peru located at more than 3000 meters above sea level. Two study periods were determined, group one represented by the first wave characterized by massive restriction and strict quarantine and the second wave where productive activities had already normalized to a great extent. Of a total of 252 patients with COVID-19, the average age was 56 years in the first wave and 52 years in the second wave, the male sex was more frequent in both 74% and 57%, mortality was 27% and 23%, the time of illness was 8 days and 10 days, respectively. On the other hand, the percentage of use of antibiotics, ivermectin and hydroxychloroquine was higher in the first wave. The use of corticosteroids and prolonged hospital stay was more frequent in the second wave. Comparison of both waves shows differences in age, mortality and time of illness, which may be due to the new molecular variants of SARS-COV-2.
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Introduction: Aneurysm formation of internal carotid arteries (ICA) in patients with mucormycosis is a scarce phenomenon. However, the prevalence of rhino-cerebral mucormycosis has been reported to increase after the Coronavirus disease 2019 (COVID-19) pandemic. Case Presentation: Three patients with stroke and subarachnoid hemorrhage presented due to ICA aneurysm after the involvement of adjacent paranasal sinuses (PNS) with mucormycosis. They had a history of diabetes and corticosteroid use. Also, one of them was treated with imatinib. Two out of the three patients were infected with SARS-CoV-2 before developing mucormycosis. Two patients had diagnostic angiography before endovascular intervention. One patient did not undergo any therapeutic intervention due to total artery occlusion, whereas the other patient experienced a successful parent artery occlusion by coiling and only survived this patient. Although all patients received antifungal treatment and surgical debridement, two of them died. Conclusions: In patients with rhino-cerebral mucormycosis, aneurysm evolution should be promptly and meticulously investigated by Magnetic Resonance Angiography (MRA) and Computed Tomography Angiography (CTA). As this type of aneurysm is very fast-growing, as soon as the involvement of the sphenoid sinus is detected, the possibility of ICA aneurysm formation should always be kept in mind. If the patient develops an aneurysm, prompt intensive antifungal therapy and therapeutic endovascular interventions such as stenting, coiling, or sacrificing should be considered as soon as possible to optimize outcomes.
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Background: COVID-19 is a global pandemic initiated in January 2020 that caused 79 million cases and more than 1.7 million deaths worldwide. The causative agent of COVID-19 is Severe Acute Respiratory Syndrome Coronavirus-2, a member of Betacoronvirus. COVID-19 patients are classified into asymptomatic, mild symptomatic, and severe symptomatic cases. Objectives: To review the prevalence, therapeutic interventions for the treatment, vaccination, and containment of COVID-19 in four quarters of 2020, emphasizing the advancements in biological studies, and the social, economic, and environmental impact of the pandemic. Methodology: Data of COVID-19 spread, identification, prevention, and control measures was analyzed. The impacts of pandemic on society, economy, and the environment were assessed.
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Aim: Patients diagnosed with Coronavirus disease 2019 (COVID-19) with underlying health problems or comorbidities tend to progress rapidly and severely. Suppressed immune systems due to uremia in hemodialysis patients and comorbidities such as hypertension (HT), diabetes mellitus (DM) and coronary artery disease (CAD) pose a risk for the severe course of the disease. In this study, we aimed to examine the clinical and laboratory findings and risk factors affecting prognosis in hemodialysis patients followed up with a diagnosis of COVID-19. Material and Method: 58 adult hemodialysis patients diagnosed with COVID-19 with clinical, laboratory and radiological findings between 01.08.2020 and 15.11.2020 were retrospectively evaluated.
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The pandemic of CoronaVirus-19 (COVID-19) is an alarming situation worldwide as it poses a considerable threat to the healthcare system. Various study results suggested the effect of COVID-19 on non-communicable diseases (NCDs) including asthma. The present study aims to review, describe and assess the impact of COVID-19 on asthma patients. The results of the current review suggest a non-significant impact of asthma on COVID-19 outcomes. However, the impact of COVID-19 on asthmatics is complex that may vary according to the clinical severity, patient age, or genetics in different populations. Hence it is needed to conduct studies with a large number of cohorts in different populations that may provide us with conclusive results. The use of corticosteroids is not recommended, but some studies suggested that by monitoring certain factors corticosteroids can be used for COVID-19 patients suffering from asthma. The future care of asthmatic patients in COVID-19 should include self-management, remote interventions, and social distancing.
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Objective: Though systemic corticosteroid is used for treatment of COVID 19, questions regarding the appropriate dose, duration and type of corticosteroid use still remain unanswered. This study aimed to address, whether choice of systemic corticosteroid significantly influences the clinical outcome of COVID 19 patients. Materials and Methods: Studies reporting the comparison between clinical outcome of dexamethasone and methylprednisolone in treatment of COVID 19 were searched from inception till April, 2021. Random-effect model was used. Odd's ratio (OR) and 95% confidence interval was expressed. I2 statistics used for test of heterogeneity. Result: Three studies with 373 patients (160 in dexamethasone group and 213 in methyl prednisolone group) were included. Though, statistically significant reduction in all-cause mortality with methyl prednisolone group in comparison to dexamethasone group (OR=1.80, 95%CI: 1.08 to 3.01, P=0.02) estimated, sub group analysis of observational studies did not support the finding (OR=1.60, 95% CI: 0.88 to 2.92, P=0.12). No significant difference in terms of need for invasive ventilator or intensive care unit (ICU) between the 2 groups. The grade of evidence was very low for both the outcomes. Conclusion and Relevance: In the present context, both dexamethasone and methyl prednisolone are equally effective in the management of COVID 19.
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Background: Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder characterised by progressive muscle weakness beginning in early childhood. Respiratory failure and weak cough develop in all patients as a consequence of muscle weakness leading to a risk of atelectasis, pneumonia, or the need for ventilatory support. There is no curative treatment for DMD. Corticosteroids are the only pharmacological intervention proven to delay the onset and progression of muscle weakness and thus respiratory decline in DMD. Antioxidant treatment has been proposed to try to reduce muscle weakness in general, and respiratory decline in particular. Objectives: To assess the effects of antioxidant agents on preventing respiratory decline in people with Duchenne muscular dystrophy during the respiratory decline phase of the condition. Search methods: We searched CENTRAL, MEDLINE, Embase, and two trials registers to 23 March 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies. Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs that met our inclusion criteria. We included male patients with a diagnosis of DMD who had respiratory decline evidenced by a forced vital capacity (FVC%) less than 80% but greater than 30% of predicted values, receiving any antioxidant agent compared with other therapies for the management of DMD or placebo. Data collection and analysis: Two review authors screened studies for eligibility, assessed risk of bias of studies, and extracted data. We used standard methods expected by Cochrane. We assessed the certainty of the evidence using the GRADE approach. The primary outcomes were FVC and hospitalisation due to respiratory infections. Secondary outcomes were quality of life, adverse events, change in muscle function, forced expiratory volume in the first second (FEV1), and peak expiratory flow (PEF). Main results: We included one study with 66 participants who were not co-treated with corticosteroids, which was the only study to contribute data to our main analysis. We also included a study that enrolled 255 participants treated with corticosteroids, which was only available as a press release without numerical results. The studies were parallel-group RCTs that assessed the effect of idebenone on respiratory function compared to placebo. The trial that contributed numerical data included patients with a mean (standard deviation) age of 14.3 (2.7) years at the time of inclusion, with a documented diagnosis of DMD or severe dystrophinopathy with clinical features consistent with typical DMD. The overall risk of bias across most outcomes was similar and judged as 'low'. Idebenone may result in a slightly less of a decline in FVC from baseline to one year compared to placebo (mean difference (MD) 3.28%, 95% confidence interval (CI) -0.41 to 6.97;64 participants;low-certainty evidence), and probably has little or no effect on change in quality of life (MD -3.80, 95% CI -10.09 to 2.49;63 participants;moderate-certainty evidence) (Pediatric Quality of Life Inventory (PedsQL), range 0 to 100, 0 = worst, 100 = best quality of life). As a related but secondary outcome, idebenone may result in less of a decline from baseline in FEV1 (MD 8.28%, 95% CI 0.89 to 15.67;53 participants) and PEF (MD 6.27%, 95% CI 0.61 to 11.93;1 trial, 64 participants) compared to placebo. Idebenone was associated with fewer serious adverse events (RR 0.42, 95% CI 0.09 to 2.04;66 participants;low-certainty evidence) and little to no difference in non-serious adverse events (RR 1.00, 95% CI 0.88 to 1.13;66 participants;low-certainty evidence) compared to placebo. Idebenone may result in little to no difference in change in arm muscle function (MD -2.45 N, 95% CI -8.60 to 3.70 for elbow flexors and MD -1.06 N, 95% CI -6.77 to 4.65 for elbow extensors;both 52 participants) compared to placebo. We found no studies evaluating the outcome hospitalisation due to respiratory infection. The second trial, involving 255 participants
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COVID-19 pneumonia represents a challenge for health systems. The objective of this study is to describe the clinical presentation and evolution of hospitalized patients with COVID-19 pneumonia. This is a prospective and descrip tive study. Patients older than 16 years with a PCR confirmed diagnosis of COVID-19 were included in 94.0% (n=395) of the cases. Biochemical and imaging determinations were made. 421 patients were included, 57.0% male (n=240), with a mean age of 56.1 .. 15.1 years. 41.0% (n=172) were older than 60 years. 79.7% (n=333) had comorbidities. They had seven days 7 days (IQR 5) from symptom onset to hospitalization. The most frequent symptoms were: dyspnea (78.1%, n=307), cough (76.5%, n=297) and fever (73.6%, n=289). 50.2% (n=204) presented respiratory failure upon admission. 63.4% (n=173) presented pathological infiltrates on radiography and 96.0% (n=312) on chest tomography. The 4C score was 8 (IQR 6). 31.6% (n=133) had a poor clinical evolution. In-hospital mortality was 18.9% (n=80) and 23.7% (n=100) received mechanical ventilation. 21.9% (n=92) presented in-hospital complications. 39.6% (n=67) of those over 60 years of age were admitted to the Intensive Care Unit and 31.4% (n=54) died. 76.9% (n=319) of the patients received corticosteroids, 69.3% (n=289) antibiotics, and convalescent plasma 10.5% (n=43). This series stands out for the high rate of co morbidities and the severity of the patients included. Mortality was similar to other international series.
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The systemic steroids are recommended for cases with refractory septic shock or severe acute respiratory distress syndrome. Although systemic glucocorticoids help to resolve inflammation and treat cytokine storm, the time course for steroid use and which patients benefit from using systemic corticosteroids is unclear. In this study, we aimed to evaluate the therapeutic effect of corticosteroids in COVID-19 patients. Electronic medical records of hospitalized patients (n=7,980) from 178 hospitals across United States for confirmed COVID-19 between January 1st 2020 and May 8th 2020 were reviewed. Of the 7,980 patients, 3,951 (49.5%) were female and 4,029 (50.5%) were male. The mean age was 57.4 .. 19 years. Fifteen percent (n=1,219) died in hospital or were discharged to hospice care. Seventy-two percent (n=5,774) required non-ICU level of care, while 28% (n=2,206) of patients required ICU, and of those 1,157 (14.5%) needed ventilator support. The mean length of stay in the hospital was 6 days (range 0 - 84 days). Fourteen percent (n=1111) of patients received at least one dose of systemic steroids during hospitalization. Sixty precent of those had ICU level of care with 435 (39%) requiring ventilator support. Overall, the use of corticosteroids was associated with increased mortality (OR=1.273;p=0.0160) and 3.53 days longer hospital stay (p<0.0001). The corticosteroid exposed group was also noted to progress to a higher level of care and have longer time on a ventilator when compared with the patients who did not receive steroids. The length of hospital stay and mortality was higher especially in severe/critical patients. Based on these results, we recommend cautious use of corticosteroids in COVID-19. The etiology behind this association is still unclear and presents an area for future research.