Effect of Different Corticosteroid Regimens on the Outcome of Severe COVID-19-Related Acute Respiratory Failure. A Retrospective Analysis.
COVID-19
acute respiratory distress syndrome (ARDS)
corticosteroids
critically ill patients
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
21 Oct 2021
21 Oct 2021
Historique:
received:
09
09
2021
revised:
11
10
2021
accepted:
18
10
2021
entrez:
13
11
2021
pubmed:
14
11
2021
medline:
14
11
2021
Statut:
epublish
Résumé
Systemic corticosteroids are associated with reduced mortality in COVID-19-related acute respiratory failure; however, the type and dose has not yet been established. To compare the outcomes of dexamethasone vs. methylprednisolone, along with the effects of rescue, short-term, high-dose boluses of corticosteroids. Before/after and case/control retrospective analysis of consecutive critically ill COVID-19 subjects. Subjects were initially given dexamethasone; however, after review of the local protocol, methylprednisolone was suggested. A three-day course of 1000 mg/day of methylprednisolone was administered in the case of refractory hypoxemia within the first 10 days of treatment. Propensity score-adjusted comparisons were performed. A total of 81 consecutive subjects were included (85% males, 60 ± 10 years, SAPS II 27 ± 7, SOFA 4 [IQR 3, 6] points) and 51 of these subjects (62.9%) received dexamethasone and 29 (35.8%) had methylprednisolone. The groups were well matched for age, comorbidities, and severity at admission. No differences were found in the duration of ICU stay, hospital mortality, or infectious complications between the groups. A total of 22 subjects (27.2%) received a rescue bolus; these subjects had a significantly lower oxygenation, a higher driving pressure, and an increased ventilatory ratio during the first ten days. Short-term/high-dose boluses were associated with higher hospital mortality, longer mechanical ventilation and ICU and hospital stay, and more infectious complications. A subgroup of subjects who received the boluses had significantly improved oxygenation and lower hospital mortality. We were unable to find any difference between dexamethasone or methylprednisolone on the explored outcomes; high-dose boluses of corticosteroids were associated with a worse outcome. However, a subgroup of subjects was identified in whom the high-dose boluses seemed beneficial.
Sections du résumé
BACKGROUND
BACKGROUND
Systemic corticosteroids are associated with reduced mortality in COVID-19-related acute respiratory failure; however, the type and dose has not yet been established.
OBJECTIVES
OBJECTIVE
To compare the outcomes of dexamethasone vs. methylprednisolone, along with the effects of rescue, short-term, high-dose boluses of corticosteroids.
METHODS
METHODS
Before/after and case/control retrospective analysis of consecutive critically ill COVID-19 subjects. Subjects were initially given dexamethasone; however, after review of the local protocol, methylprednisolone was suggested. A three-day course of 1000 mg/day of methylprednisolone was administered in the case of refractory hypoxemia within the first 10 days of treatment. Propensity score-adjusted comparisons were performed.
RESULTS
RESULTS
A total of 81 consecutive subjects were included (85% males, 60 ± 10 years, SAPS II 27 ± 7, SOFA 4 [IQR 3, 6] points) and 51 of these subjects (62.9%) received dexamethasone and 29 (35.8%) had methylprednisolone. The groups were well matched for age, comorbidities, and severity at admission. No differences were found in the duration of ICU stay, hospital mortality, or infectious complications between the groups. A total of 22 subjects (27.2%) received a rescue bolus; these subjects had a significantly lower oxygenation, a higher driving pressure, and an increased ventilatory ratio during the first ten days. Short-term/high-dose boluses were associated with higher hospital mortality, longer mechanical ventilation and ICU and hospital stay, and more infectious complications. A subgroup of subjects who received the boluses had significantly improved oxygenation and lower hospital mortality.
CONCLUSIONS
CONCLUSIONS
We were unable to find any difference between dexamethasone or methylprednisolone on the explored outcomes; high-dose boluses of corticosteroids were associated with a worse outcome. However, a subgroup of subjects was identified in whom the high-dose boluses seemed beneficial.
Identifiants
pubmed: 34768369
pii: jcm10214847
doi: 10.3390/jcm10214847
pmc: PMC8584858
pii:
doi:
Types de publication
Journal Article
Langues
eng
Références
J Clin Virol. 2004 Dec;31(4):304-9
pubmed: 15494274
Intensive Care Med. 2017 Dec;43(12):1751-1763
pubmed: 28940011
Nat Rev Immunol. 2013 Jan;13(1):34-45
pubmed: 23222502
N Engl J Med. 2020 Apr 30;382(18):1708-1720
pubmed: 32109013
Clin Infect Dis. 2020 Apr 27;:
pubmed: 32338708
Curr Opin Microbiol. 2007 Feb;10(1):52-6
pubmed: 17208512
JAMA. 2020 Oct 6;324(13):1307-1316
pubmed: 32876695
Lancet Infect Dis. 2020 Oct;20(10):1135-1140
pubmed: 32526193
Intensive Care Med. 2020 Jun;46(6):1089-1098
pubmed: 32367170
Crit Care Med. 2020 Jun;48(6):e440-e469
pubmed: 32224769
JAMA. 2020 Oct 6;324(13):1298-1306
pubmed: 32876689
JAMA Intern Med. 2020 Jul 1;180(7):934-943
pubmed: 32167524
JAMA. 2020 Oct 6;324(13):1292-1295
pubmed: 32876693
Front Immunol. 2020 Aug 28;11:2145
pubmed: 32983174
N Engl J Med. 2021 Feb 25;384(8):693-704
pubmed: 32678530
Am J Respir Crit Care Med. 2003 Dec 15;168(12):1449-56
pubmed: 12947028
JAMA. 2020 Apr 28;323(16):1574-1581
pubmed: 32250385
Respirol Case Rep. 2020 Jun 04;8(6):e00596
pubmed: 32514354
Intensive Care Med. 2020 Nov;46(11):2067-2070
pubmed: 33026460
Nature. 2020 May;581(7809):465-469
pubmed: 32235945
JAMA. 2020 Oct 6;324(13):1317-1329
pubmed: 32876697
JAMA. 2020 Oct 6;324(13):1330-1341
pubmed: 32876694
N Engl J Med. 2020 Jun 11;382(24):2372-2374
pubmed: 32302078
J Med Virol. 2020 Nov;92(11):2866-2869
pubmed: 32530507
Med Clin (Barc). 2020 Aug 28;155(4):159-161
pubmed: 32532461
Respir Res. 2017 Dec 12;18(1):207
pubmed: 29233147
Am J Respir Crit Care Med. 2019 Feb 1;199(3):333-341
pubmed: 30211618
Lancet Respir Med. 2020 Mar;8(3):267-276
pubmed: 32043986
Minerva Anestesiol. 2020 May;86(5):469-472
pubmed: 32242647
Semin Immunopathol. 2013 Jul;35(4):465-80
pubmed: 23595413
Lancet. 2004 May 22;363(9422):1699-700
pubmed: 15158632
Clin Chem Lab Med. 2020 Jun 25;58(7):1021-1028
pubmed: 32286245
Allergy. 2020 Jul;75(7):1564-1581
pubmed: 32396996
Minerva Anestesiol. 2020 Nov;86(11):1234-1245
pubmed: 33228329
Lancet. 2020 Feb 15;395(10223):473-475
pubmed: 32043983
Chest. 2009 Dec;136(6):1631-1643
pubmed: 19801579
Am J Respir Crit Care Med. 2018 Mar 15;197(6):757-767
pubmed: 29161116
Intensive Care Med. 2020 Aug;46(8):1603-1606
pubmed: 32415314