Brian C Nelson1, Justin Laracy2, Sherif Shoucri2, Donald Dietz2, Jason Zucker2, Nina Patel3, Magdalena E Sobieszczyk2, Christine J Kubin1, Angela Gomez-Simmonds2. 1. Department of Pharmacy, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA. 2. Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA. 3. Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Columbia University Irving Medical Center, New York, New York, USA.
Abstract
BACKGROUND: The efficacy and safety of methylprednisolone in mechanically ventilated patients with acute respiratory distress syndrome resulting from coronavirus disease 2019 (COVID-19) are unclear. In this study, we evaluated the association between use of methylprednisolone and key clinical outcomes. METHODS: Clinical outcomes associated with the use of methylprednisolone were assessed in an unmatched, case-control study; a subset of patients also underwent propensity-score matching. Patients were admitted between 1 March and 12 April, 2020. The primary outcome was ventilator-free days by 28 days after admission. Secondary outcomes included extubation, mortality, discharge, positive cultures, and hyperglycemia. RESULTS: A total of 117 patients met inclusion criteria. Propensity matching yielded a cohort of 42 well-matched pairs. Groups were similar except for hydroxychloroquine and azithromycin use, which were more common in patients who did not receive methylprednisolone. Mean ventilator-free days were significantly higher in patients treated with methylprednisolone (6.21 ± 7.45 vs 3.14 ± 6.22; P = .044). The probability of extubation was also increased in patients receiving methylprednisolone (45% vs 21%; P = .021), and there were no significant differences in mortality (19% vs 36%; P = .087). In a multivariable linear regression analysis, only methylprednisolone use was associated with a higher number of ventilator-free days (P = .045). The incidence of positive cultures and hyperglycemia were similar between groups. CONCLUSIONS: Methylprednisolone was associated with increased ventilator-free days and higher probability of extubation in a propensity-score matched cohort. Randomized, controlled studies are needed to further define methylprednisolone use in patients with COVID-19.
BACKGROUND: The efficacy and safety of methylprednisolone in mechanically ventilated patients with acute respiratory distress syndrome resulting from coronavirus disease 2019 (COVID-19) are unclear. In this study, we evaluated the association between use of methylprednisolone and key clinical outcomes. METHODS: Clinical outcomes associated with the use of methylprednisolone were assessed in an unmatched, case-control study; a subset of patients also underwent propensity-score matching. Patients were admitted between 1 March and 12 April, 2020. The primary outcome was ventilator-free days by 28 days after admission. Secondary outcomes included extubation, mortality, discharge, positive cultures, and hyperglycemia. RESULTS: A total of 117 patients met inclusion criteria. Propensity matching yielded a cohort of 42 well-matched pairs. Groups were similar except for hydroxychloroquine and azithromycin use, which were more common in patients who did not receive methylprednisolone. Mean ventilator-free days were significantly higher in patients treated with methylprednisolone (6.21 ± 7.45 vs 3.14 ± 6.22; P = .044). The probability of extubation was also increased in patients receiving methylprednisolone (45% vs 21%; P = .021), and there were no significant differences in mortality (19% vs 36%; P = .087). In a multivariable linear regression analysis, only methylprednisolone use was associated with a higher number of ventilator-free days (P = .045). The incidence of positive cultures and hyperglycemia were similar between groups. CONCLUSIONS: Methylprednisolone was associated with increased ventilator-free days and higher probability of extubation in a propensity-score matched cohort. Randomized, controlled studies are needed to further define methylprednisolone use in patients with COVID-19.
Authors: Katherine L Hoffman; Edward J Schenck; Michael J Satlin; William Whalen; Di Pan; Nicholas Williams; Iván Díaz Journal: JAMA Netw Open Date: 2022-10-03
Authors: Katherine L Hoffman; Edward J Schenck; Michael J Satlin; William Whalen; Di Pan; Nicholas Williams; Iván Díaz Journal: medRxiv Date: 2022-06-07
Authors: Judith van Paassen; Jeroen S Vos; Eva M Hoekstra; Katinka M I Neumann; Pauline C Boot; Sesmu M Arbous Journal: Crit Care Date: 2020-12-14 Impact factor: 9.097
Authors: Chunxue Bai; Sanjay H Chotirmall; Jordi Rello; George A Alba; Leo C Ginns; Jerry A Krishnan; Robert Rogers; Elisabeth Bendstrup; Pierre-Regis Burgel; James D Chalmers; Abigail Chua; Kristina A Crothers; Abhijit Duggal; Yeon Wook Kim; John G Laffey; Carlos M Luna; Michael S Niederman; Ganesh Raghu; Julio A Ramirez; Jordi Riera; Oriol Roca; Maximiliano Tamae-Kakazu; Antoni Torres; Richard R Watkins; Miriam Barrecheguren; Mirko Belliato; Hassan A Chami; Rongchang Chen; Gustavo A Cortes-Puentes; Charles Delacruz; Margaret M Hayes; Leo M A Heunks; Steven R Holets; Catherine L Hough; Sugeet Jagpal; Kyeongman Jeon; Takeshi Johkoh; May M Lee; Janice Liebler; Gerry N McElvaney; Ari Moskowitz; Richard A Oeckler; Iñigo Ojanguren; Anthony O'Regan; Mathias W Pletz; Chin Kook Rhee; Marcus J Schultz; Enrico Storti; Charlie Strange; Carey C Thomson; Francesca J Torriani; Xun Wang; Wim Wuyts; Tao Xu; Dawei Yang; Ziqiang Zhang; Kevin C Wilson Journal: Eur Respir Rev Date: 2020-10-05