OBJECTIVES: To assess the influence of corticosteroid pulses on 60-day mortality in hospitalized patients with severe COVID-19. METHODS: We designed a multicenter retrospective cohort study in three teaching hospitals of Castilla y León, Spain (865,096 people). We selected patients with confirmed COVID-19 and lung involvement with a pO2/FiO2<300, excluding those exposed to immunosuppressors before or during hospitalization, patients terminally ill at admission, or those who died in the first 24 hours. We performed a propensity score matching (PSM) adjusting covariates that modify the probability of being treated. Then, we used a Cox regression model in the PSM group to consider factors affecting mortality. RESULTS: From 2933 patients, 257 fulfilled the inclusion and exclusion criteria. 124 patients were on corticosteroid pulses (250 mg of methylprednisolone for three days), and 133 were not. 30.3% (37/122) of patients died in the corticosteroid pulse group and 42.9% (57/133) in the nonexposed cohort. These differences (12.6%, 95% CI [8·54-16.65]) were statically significant (log-rank 4.72, p = 0, 03). We performed PSM using the exact method. Mortality differences remained in the PSM group (log-rank 5.31, p = 0.021) and were still significant after a Cox regression model (HR for corticosteroid pulses 0.561; p = 0.039). CONCLUSIONS: This study provides evidence about treatment with corticosteroid pulses in severe COVID-19 that might significantly reduce mortality. Strict inclusion and exclusion criteria with that selection process set a reliable frame to compare mortality in both the exposed and nonexposed groups.
OBJECTIVES: To assess the influence of corticosteroid pulses on 60-day mortality in hospitalized patients with severe COVID-19. METHODS: We designed a multicenter retrospective cohort study in three teaching hospitals of Castilla y León, Spain (865,096 people). We selected patients with confirmed COVID-19 and lung involvement with a pO2/FiO2<300, excluding those exposed to immunosuppressors before or during hospitalization, patients terminally ill at admission, or those who died in the first 24 hours. We performed a propensity score matching (PSM) adjusting covariates that modify the probability of being treated. Then, we used a Cox regression model in the PSM group to consider factors affecting mortality. RESULTS: From 2933 patients, 257 fulfilled the inclusion and exclusion criteria. 124 patients were on corticosteroid pulses (250 mg of methylprednisolone for three days), and 133 were not. 30.3% (37/122) of patients died in the corticosteroid pulse group and 42.9% (57/133) in the nonexposed cohort. These differences (12.6%, 95% CI [8·54-16.65]) were statically significant (log-rank 4.72, p = 0, 03). We performed PSM using the exact method. Mortality differences remained in the PSM group (log-rank 5.31, p = 0.021) and were still significant after a Cox regression model (HR for corticosteroid pulses 0.561; p = 0.039). CONCLUSIONS: This study provides evidence about treatment with corticosteroid pulses in severe COVID-19 that might significantly reduce mortality. Strict inclusion and exclusion criteria with that selection process set a reliable frame to compare mortality in both the exposed and nonexposed groups.
Authors: G R Bernard; J M Luce; C L Sprung; J E Rinaldo; R M Tate; W J Sibbald; K Kariman; S Higgins; R Bradley; C A Metz Journal: N Engl J Med Date: 1987-12-17 Impact factor: 91.245
Authors: Fatimah S Dawood; Seema Jain; Lyn Finelli; Michael W Shaw; Stephen Lindstrom; Rebecca J Garten; Larisa V Gubareva; Xiyan Xu; Carolyn B Bridges; Timothy M Uyeki Journal: N Engl J Med Date: 2009-05-07 Impact factor: 91.245
Authors: José Luis Callejas Rubio; Juan de Dios Luna Del Castillo; Javier de la Hera Fernández; Emilio Guirao Arrabal; Manuel Colmenero Ruiz; Norberto Ortego Centeno Journal: Med Clin (Barc) Date: 2020-05-27 Impact factor: 1.725
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: Thinh N Bui; Nhat M Huynh; Nguyen-Huy Do-Tran; Hoang-Anh Ngo; Hung Tran; Nhan T Nguyen; Tung T Pham; Kha D Le; Thu-Anh Nguyen Journal: Case Rep Womens Health Date: 2022-02-09
Authors: David Andaluz-Ojeda; Pablo Vidal-Cortes; Álvaro Aparisi Sanz; Borja Suberviola; Lorena Del Río Carbajo; Leonor Nogales Martín; Estefanía Prol Silva; Jorge Nieto Del Olmo; José Barberán; Ivan Cusacovich Journal: World J Crit Care Med Date: 2022-07-09