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Corticosteroid treatment in severe patients with SARS-CoV-2 and chronic HBV co-infection: a retrospective multicenter study.
Meng, Mei; Chu, Yufeng; Zhang, Sheng; Li, Xuechuan; Sha, Jing; Wang, Peng; Cui, Yunliang; Han, Meihong; Dong, Xuan; Sun, Wenqing; Zhang, Zhongfa; Deng, Yunxin; Wang, Tao; Annane, Djillali; Jia, Shouqiang; Chen, Dechang.
  • Meng M; Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No 197, Rui Jin 2nd Road, Shanghai, 200025, China.
  • Chu Y; Department of Critical Care Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
  • Zhang S; Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No 197, Rui Jin 2nd Road, Shanghai, 200025, China.
  • Li X; Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
  • Sha J; Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
  • Wang P; Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
  • Cui Y; Department of Critical Care Medicine, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, Shandong, China.
  • Han M; Department of Infectious Disease, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
  • Dong X; Tuberculosis and Respiratory Department, Wuhan Infectious Diseases Hospital, Wuhan, China.
  • Sun W; Department of Intensive Care Unit, Shandong Provincial Chest Hospital, Jinan, China.
  • Zhang Z; Jinan Infectious Diseases Hospital, Shandong University, Jinan, China.
  • Deng Y; Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No 197, Rui Jin 2nd Road, Shanghai, 200025, China.
  • Wang T; Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No 197, Rui Jin 2nd Road, Shanghai, 200025, China.
  • Annane D; General Intensive Care Unit, Raymond Poincaré Hospital (APHP), Laboratory of Inflammation and Infection U1173, FHU SEPSIS, RHU RECORDS, University Paris Saclay-Campus UVSQ, 104 Bd Raymond Poincaré, 92380, Garches, France. djillali.annane@aphp.fr.
  • Jia S; Department of Radiology, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China. jshqlw@163.com.
  • Chen D; Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No 197, Rui Jin 2nd Road, Shanghai, 200025, China. 15168887139@163.com.
BMC Infect Dis ; 22(1): 891, 2022 Nov 28.
Article in English | MEDLINE | ID: covidwho-2139180
ABSTRACT

BACKGROUND:

The impact of corticosteroids on patients with severe coronavirus disease 2019 (COVID-19)/chronic hepatitis B virus (HBV) co-infection is currently unknown. We aimed to investigate the association of corticosteroids on these patients.

METHODS:

This retrospective multicenter study screened 5447 confirmed COVID-19 patients hospitalized between Jan 1, 2020 to Apr 18, 2020 in seven centers in China, where the prevalence of chronic HBV infection is moderate to high. Severe patients who had chronic HBV and acute SARS-cov-2 infection were potentially eligible. The diagnosis of chronic HBV infection was based on positive testing for hepatitis B surface antigen (HBsAg) or HBV DNA during hospitalization and a medical history of chronic HBV infection. Severe patients (meeting one of following criteria respiratory rate > 30 breaths/min; severe respiratory distress; or SpO2 ≤ 93% on room air; or oxygen index < 300 mmHg) with COVID-19/HBV co-infection were identified. The bias of confounding variables on corticosteroids effects was minimized using multivariable logistic regression model and inverse probability of treatment weighting (IPTW) based on propensity score.

RESULTS:

The prevalence of HBV co-infection in COVID-19 patients was 4.1%. There were 105 patients with severe COVID-19/HBV co-infections (median age 62 years, 57.1% male). Fifty-five patients received corticosteroid treatment and 50 patients did not. In the multivariable analysis, corticosteroid therapy (OR, 6.32, 95% CI 1.17-34.24, P = 0.033) was identified as an independent risk factor for 28-day mortality. With IPTW analysis, corticosteroid treatment was associated with delayed SARS-CoV-2 viral RNA clearance (OR, 2.95, 95% CI 1.63-5.32, P < 0.001), increased risk of 28-day and in-hospital mortality (OR, 4.90, 95% CI 1.68-14.28, P = 0.004; OR, 5.64, 95% CI 1.95-16.30, P = 0.001, respectively), and acute liver injury (OR, 4.50, 95% CI 2.57-7.85, P < 0.001). Methylprednisolone dose per day and cumulative dose in non-survivors were significantly higher than in survivors.

CONCLUSIONS:

In patients with severe COVID-19/HBV co-infection, corticosteroid treatment may be associated with increased risk of 28-day and in-hospital mortality.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Hepatitis B, Chronic / Coinfection / COVID-19 Drug Treatment / Hepatitis B Type of study: Experimental Studies / Observational study / Prognostic study Topics: Long Covid / Variants Limits: Female / Humans / Male / Middle aged Language: English Journal: BMC Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: S12879-022-07882-6

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Hepatitis B, Chronic / Coinfection / COVID-19 Drug Treatment / Hepatitis B Type of study: Experimental Studies / Observational study / Prognostic study Topics: Long Covid / Variants Limits: Female / Humans / Male / Middle aged Language: English Journal: BMC Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: S12879-022-07882-6