Glycemic control is associated with lower odds of mortality and successful extubation in severe COVID-19.
COVID-19
corticosteroids
glycemic control
hyperglycemia
Journal
Journal of osteopathic medicine
ISSN: 2702-3648
Titre abrégé: J Osteopath Med
Pays: Germany
ID NLM: 101776472
Informations de publication
Date de publication:
16 12 2021
16 12 2021
Historique:
received:
12
07
2021
accepted:
21
09
2021
pubmed:
16
12
2021
medline:
2
2
2022
entrez:
15
12
2021
Statut:
epublish
Résumé
Corticosteroids, specifically dexamethasone, have become the mainstay of treatment for moderate to severe COVID-19. Although the RECOVERY trial did not report adverse effects of corticosteroids, the METCOVID (Methylprednisolone as Adjunctive Therapy for Patients Hospitalized with COVID-19) study reported a higher blood glucose level in patients receiving methylprednisolone. This study aims to analyze the association between corticosteroids and COVID-19-related outcomes in patients admitted to the medical ICU (MICU) for COVID-19 pneumonia. This is an observational study of 141 patients admitted to the MICU between March 18 and June 7, 2020. Data on demographics, laboratory and imaging studies, and clinical course were obtained, including data on corticosteroid use. Bivariate analyses and logistic regression were performed between patient characteristics and mortality and successful extubation. Of the 141 patients, 86 required mechanical ventilation, 50 received steroids, and 71 died. Regarding demographics, patients had a median age of 58 (interquartile range [IQR] 48, 65), Hispanic (57.4%, n=81), and non-Hispanic Black (37.5%, n=53). The most prevalent comorbidities were hypertension (49.6%, n=70) and diabetes (48.2%, n=68). Lower blood glucose levels on admission (125.5 vs. 148 mg/dL, p=0.025) and lower peak blood glucose levels on corticosteroids (215.5 vs. 361 mg/dL, p=0.0021) were associated with lower prevalence of mortality. Patients who were successfully extubated had a lower admission blood glucose (126.5 vs. 149 mg/dL, p=0.0074) and lower peak blood glucose on corticosteroids (217 vs. 361 mg/dL, p=0.0023). Lower blood glucose on admission and lower maximum blood glucose on corticosteroids were associated with lower odds of mortality and successful extubation, regardless of preexisting diabetes. Hyperglycemia may be negating any potential benefit of corticosteroid therapy. These findings suggest that glucose control could be a parameter that impacts the outcome of patients receiving corticosteroids for COVID-19 pneumonia.
Identifiants
pubmed: 34908253
pii: jom-2021-0182
doi: 10.1515/jom-2021-0182
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
111-115Informations de copyright
© 2021 Jay M. Pescatore et al., published by De Gruyter, Berlin/Boston.
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