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Do high-dose corticosteroids improve outcomes in hospitalized COVID-19 patients?
Kumar, Gagan; Patel, Dhaval; Hererra, Martin; Jefferies, David; Sakhuja, Ankit; Meersman, Mark; Dalton, Drew; Nanchal, Rahul; Guddati, Achuta Kumar.
  • Kumar G; Department of Pulmonary and Critical Care, Northeast Georgia Health System, Gainesville, Georgia, USA.
  • Patel D; Department of Pulmonary and Critical Care, Northeast Georgia Health System, Gainesville, Georgia, USA.
  • Hererra M; Department of Internal Medicine, Northeast Georgia Health System, Gainesville, Georgia, USA.
  • Jefferies D; Department of Pulmonary and Critical Care, Northeast Georgia Health System, Gainesville, Georgia, USA.
  • Sakhuja A; Division of Cardiovascular Critical Care, Department of Cardiovascular and Thoracic surgery, West Virginia University, West Virginia, USA.
  • Meersman M; IPC Global, Alpharetta, Georgia, USA.
  • Dalton D; IPC Global, Alpharetta, Georgia, USA.
  • Nanchal R; Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
  • Guddati AK; Division of Hematology/Oncology, Georgia Cancer Center, Augusta University, Augusta, Georgia, USA.
J Med Virol ; 94(1): 372-379, 2022 01.
Article in English | MEDLINE | ID: covidwho-1437057
ABSTRACT
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Methylprednisolone / Adrenal Cortex Hormones / Acute Kidney Injury / COVID-19 / COVID-19 Drug Treatment Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: J Med Virol Year: 2022 Document Type: Article Affiliation country: Jmv.27357

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Methylprednisolone / Adrenal Cortex Hormones / Acute Kidney Injury / COVID-19 / COVID-19 Drug Treatment Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: J Med Virol Year: 2022 Document Type: Article Affiliation country: Jmv.27357