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Use of glucocorticoids megadoses in SARS-CoV-2 infection in a spanish registry: SEMI-COVID-19.
Lavilla Olleros, Cristina; Ausín García, Cristina; Bendala Estrada, Alejandro David; Muñoz, Ana; Wikman Jogersen, Philip Erick; Fernández Cruz, Ana; Giner Galvañ, Vicente; Vargas, Juan Antonio; Seguí Ripoll, José Miguel; Rubio-Rivas, Manuel; Miranda Godoy, Rodrigo; Mérida Rodrigo, Luis; Fonseca Aizpuru, Eva; Arnalich Fernández, Francisco; Artero, Arturo; Loureiro Amigo, Jose; García García, Gema María; Corral Gudino, Luis; Jiménez Torres, Jose; Casas-Rojo, José-Manuel; Millán Núñez-Cortés, Jesús.
  • Lavilla Olleros C; General Internal Medicine Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.
  • Ausín García C; General Internal Medicine Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.
  • Bendala Estrada AD; General Internal Medicine Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.
  • Muñoz A; General Internal Medicine Department, Infanta Cristina Hospital: Hospital Universitario Infanta 2 Cristina, Parla-Madrid, Spain.
  • Wikman Jogersen PE; General Internal Medicine Department, Hospital Universitario San Juan de Alicante, San Juan de Alicante-Alicante, Spain.
  • Fernández Cruz A; General Internal Medicine Department, Hospital Universitario Puerta de Hierro, Madrid, Spain.
  • Giner Galvañ V; General Internal Medicine Department, Hospital Universitario San Juan de Alicante, San Juan de Alicante-Alicante, Spain.
  • Vargas JA; General Internal Medicine Department, Hospital Universitario Puerta de Hierro, Madrid, Spain.
  • Seguí Ripoll JM; General Internal Medicine Department, Hospital Universitario San Juan de Alicante, San Juan de Alicante-Alicante, Spain.
  • Rubio-Rivas M; General Internal Medicine Department, H. Univ. de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
  • Miranda Godoy R; General Internal Medicine Department, 12th of October University Hospital: Hospital Universitario 12 de Octubre, Madrid, Spain.
  • Mérida Rodrigo L; General Internal Medicine Department, Hospital Costa del Sol, Málaga, Spain.
  • Fonseca Aizpuru E; General Internal Medicine Department, Hospital de Cabueñes: Hospital de Cabuenes, Gijón, Spain.
  • Arnalich Fernández F; General Internal Medicine Department, La Paz University Hospital: Hospital Universitario La Paz, Madrid, Spain.
  • Artero A; General Internal Medicine Department, Hospital Universitario Dr Peset: Hospital Universitario Doctor Peset, Valencia, Spain.
  • Loureiro Amigo J; General Internal Medicine Department, Hospital de Sant Joan Despí Moisès Broggi: Hospital de Sant Joan Despi Moises Broggi, Barcelona, Spain.
  • García García GM; General Internal Medicine Department, University Hospital Complex Badajoz: Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain.
  • Corral Gudino L; Hospital Universitario Rio Ortega, Valladolid, Spain.
  • Jiménez Torres J; General Internal Medicine Department, Hospital Reina Sofía: Hospital Reina Sofia, Córdoba, Madrid, Spain.
  • Casas-Rojo JM; General Internal Medicine Department, Infanta Cristina Hospital: Hospital Universitario Infanta Cristina, Parla-Madrid, Spain.
  • Millán Núñez-Cortés J; General Internal Medicine Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.
PLoS One ; 17(1): e0261711, 2022.
Article in English | MEDLINE | ID: covidwho-1643247
ABSTRACT

OBJECTIVE:

To describe the impact of different doses of corticosteroids on the evolution of patients with COVID-19 pneumonia, based on the potential benefit of the non-genomic mechanism of these drugs at higher doses.

METHODS:

Observational study using data collected from the SEMI-COVID-19 Registry. We evaluated the epidemiological, radiological and analytical scenario between patients treated with megadoses therapy of corticosteroids vs low-dose of corticosteroids and the development of complications. The primary endpoint was all-cause in-hospital mortality according to use of corticosteroids megadoses.

RESULTS:

Of a total of 14,921 patients, corticosteroids were used in 5,262 (35.3%). Of them, 2,216 (46%) specifically received megadoses. Age was a factor that differed between those who received megadoses therapy versus those who did not in a significant manner (69 years [IQR 59-79] vs 73 years [IQR 61-83]; p < .001). Radiological and analytical findings showed a higher use of megadoses therapy among patients with an interstitial infiltrate and elevated inflammatory markers associated with COVID-19. In the univariate study it appears that steroid use is associated with increased mortality (OR 2.07 95% CI 1.91-2.24 p < .001) and megadose use with increased survival (OR 0.84 95% CI 0.75-0.96, p 0.011), but when adjusting for possible confounding factors, it is observed that the use of megadoses is also associated with higher mortality (OR 1.54, 95% CI 1.32-1.80; p < .001). There is no difference between megadoses and low-dose (p .298). Although, there are differences in the use of megadoses versus low-dose in terms of complications, mainly infectious, with fewer pneumonias and sepsis in the megadoses group (OR 0.82 95% CI 0.71-0.95; p < .001 and OR 0.80 95% CI 0.65-0.97; p < .001) respectively.

CONCLUSION:

There is no difference in mortality with megadoses versus low-dose, but there is a lower incidence of infectious complications with glucocorticoid megadoses.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Prednisone / Registries / Adrenal Cortex Hormones / Sepsis / SARS-CoV-2 / COVID-19 / COVID-19 Drug Treatment Type of study: Experimental Studies / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0261711

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Prednisone / Registries / Adrenal Cortex Hormones / Sepsis / SARS-CoV-2 / COVID-19 / COVID-19 Drug Treatment Type of study: Experimental Studies / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0261711