Your browser doesn't support javascript.
Comparison of pulse-dose and high-dose corticosteroids with no corticosteroid treatment for COVID-19 pneumonia in the intensive care unit.
Yaqoob, Hamid; Greenberg, Daniel; Hwang, Frank; Lee, Curtis; Vernik, David; Manglani, Ravi; Wang, Zhen; Murad, M Hassan; Chandy, Dipak; Epelbaum, Oleg.
  • Yaqoob H; Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, New York, USA.
  • Greenberg D; Department of Medicine, Westchester Medical Center, Valhalla, New York, USA.
  • Hwang F; New York Medical College, Valhalla, New York, USA.
  • Lee C; New York Medical College, Valhalla, New York, USA.
  • Vernik D; New York Medical College, Valhalla, New York, USA.
  • Manglani R; Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, New York, USA.
  • Wang Z; Evidence-Based Practice Center, Mayo Clinic, Rochester, New York, USA.
  • Murad MH; Evidence-Based Practice Center, Mayo Clinic, Rochester, New York, USA.
  • Chandy D; Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, New York, USA.
  • Epelbaum O; Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, New York, USA.
J Med Virol ; 94(1): 349-356, 2022 01.
Article in English | MEDLINE | ID: covidwho-1427138
ABSTRACT
Corticosteroid dosing in the range of 0.5-2 mg/kg/day of methylprednisolone equivalents has become a standard part of the management of intensive care unit (ICU) patients with COVID-19 pneumonia based on positive results of randomized trials and a meta-analysis. Alongside such conventional dosing, administration of 1 gm of methylprednisolone daily (pulse dosing) has also been reported in the literature with claims of favorable outcomes. Comparisons between such disparate approaches to corticosteroids for Coronavirus disease 2019 (COVID-19) pneumonia are lacking. In this retrospective study of patients admitted to the ICU with COVID-19 pneumonia, we compared patients treated with 0.5-2 mg/kg/day in methylprednisolone equivalents (high-dose corticosteroids) and patients treated with 1 gm of methylprednisolone (pulse-dose corticosteroids) to those who did not receive any corticosteroids. The endpoints of interest were hospital mortality, ICU-free days at Day 28, and complications potentially attributable to corticosteroids. Pulse-dose corticosteroid therapy was associated with a significant increase in ICU-free days at Day 28 compared to no receipt adjusted relative risk (aRR) 1.45 (95% confidence interval [CI] 1.05-2.02; p = 0.03) and compared with high-dose corticosteroid administration (p = 0.003). Nonetheless, receipt of high-dose corticosteroids-but not of pulse-dose corticosteroids-significantly reduced the odds of hospital mortality compared to no receipt adjusted Odds ratio (aOR) 0.31 (95% CI 0.12-0.77; p = 0.01). High-dose corticosteroids reduced mortality compared to pulse-dose corticosteroids (p = 0.04). Pulse-dose corticosteroids-but not high-dose corticosteroids-significantly increased the odds of acute kidney injury requiring renal replacement therapy compared to no receipt aOR 3.53 (95% CI 1.27-9.82; p = 0.02). The odds of this complication were also significantly higher in the pulse-dose group when compared to the high-dose group (p = 0.05 for the comparison). In this single-center study, pulse-dose corticosteroid therapy for COVID-19 pneumonia in the ICU was associated with an increase in ICU-free days but failed to impact hospital mortality, perhaps because of its association with development of severe renal failure. In line with existing trial data, the effect of high-dose corticosteroids on mortality was favorable.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Methylprednisolone / Adrenal Cortex Hormones / Pulse Therapy, Drug / Acute Kidney Injury / COVID-19 / COVID-19 Drug Treatment Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews Limits: Humans Language: English Journal: J Med Virol Year: 2022 Document Type: Article Affiliation country: Jmv.27351

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Methylprednisolone / Adrenal Cortex Hormones / Pulse Therapy, Drug / Acute Kidney Injury / COVID-19 / COVID-19 Drug Treatment Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews Limits: Humans Language: English Journal: J Med Virol Year: 2022 Document Type: Article Affiliation country: Jmv.27351