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High-dose methylprednisolone in nonintubated patients with severe COVID-19 pneumonia.
Papamanoli, Aikaterini; Yoo, Jeanwoo; Grewal, Prabhjot; Predun, William; Hotelling, Jessica; Jacob, Robin; Mojahedi, Azad; Skopicki, Hal A; Mansour, Mohamed; Marcos, Luis A; Kalogeropoulos, Andreas P.
  • Papamanoli A; Division of Infectious Diseases, Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
  • Yoo J; Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
  • Grewal P; Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
  • Predun W; Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
  • Hotelling J; Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
  • Jacob R; Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
  • Mojahedi A; Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
  • Skopicki HA; Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
  • Mansour M; Division of Pulmonary & Critical Care Medicine, Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
  • Marcos LA; Division of Infectious Diseases, Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
  • Kalogeropoulos AP; Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
Eur J Clin Invest ; 51(2): e13458, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1066670
ABSTRACT

BACKGROUND:

Recent trials with dexamethasone and hydrocortisone have demonstrated benefit in patients with coronavirus disease 2019 (COVID-19). Data on methylprednisolone are limited.

METHODS:

Retrospective cohort of consecutive adults with severe COVID-19 pneumonia on high-flow oxygen (FiO2  ≥ 50%) admitted to an academic centre in New York, from 1 March to 15 April 2020. We used inverse probability of treatment weights to estimate the effect of methylprednisolone on clinical outcomes and intensive care resource utilization.

RESULTS:

Of 447 patients, 153 (34.2%) received methylprednisolone and 294 (65.8%) received no corticosteroids. At 28 days, 102 patients (22.8%) had died and 115 (25.7%) received mechanical ventilation. In weighted analyses, risk for death or mechanical ventilation was 37% lower with methylprednisolone (hazard ratio 0.63; 95% CI 0.47-0.86; P = .003), driven by less frequent mechanical ventilation (subhazard ratio 0.56; 95% CI 0.40-0.79; P = .001); mortality did not differ between groups. The methylprednisolone group had 2.8 more ventilator-free days (95% CI 0.5-5.1; P = .017) and 2.6 more intensive care-free days (95% CI 0.2-4.9; P = .033) during the first 28 days. Complication rates were not higher with methylprednisolone.

CONCLUSIONS:

In nonintubated patients with severe COVID-19 pneumonia, methylprednisolone was associated with reduced need for mechanical ventilation and less-intensive care resource utilization without excess complications.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Oxygen Inhalation Therapy / Respiration, Artificial / Methylprednisolone / Continuous Positive Airway Pressure / COVID-19 / Glucocorticoids / Intensive Care Units Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Eur J Clin Invest Year: 2021 Document Type: Article Affiliation country: Eci.13458

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Oxygen Inhalation Therapy / Respiration, Artificial / Methylprednisolone / Continuous Positive Airway Pressure / COVID-19 / Glucocorticoids / Intensive Care Units Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Eur J Clin Invest Year: 2021 Document Type: Article Affiliation country: Eci.13458