Steroid exposure and outcome in COVID-19 pneumonia.
COVID-19
acute respiratory distress syndrome
corticosteroid
mechanical ventilation
steroid
Journal
BJA open
ISSN: 2772-6096
Titre abrégé: BJA Open
Pays: England
ID NLM: 9918419157906676
Informations de publication
Date de publication:
Mar 2023
Mar 2023
Historique:
received:
03
12
2022
revised:
12
01
2023
accepted:
23
01
2023
pubmed:
7
2
2023
medline:
7
2
2023
entrez:
6
2
2023
Statut:
ppublish
Résumé
Corticosteroids are used to treat COVID-19 pneumonia. However, the optimal dose is unclear. This study describes the association between corticosteroid exposure with disease severity and outcome in COVID-19 pneumonia. This is a single-centre retrospective, observational study including adult ICU patients who received systemic corticosteroids for COVID-19 pneumonia between March 2020 and March 2021. We recorded patient characteristics, disease severity, total steroid exposure, respiratory support and gas exchange data, and 90-day mortality. We included 362 patients. We allocated patients to groups with increasing disease severity according to the highest level of respiratory support that they received: high-flow nasal oxygen or continuous positive airway pressure (HFNO/CPAP) in 12.7%, invasive mechanical ventilation (IMV) in 61.6%, and extracorporeal membrane oxygenation (ECMO) in 25.7%. For these three groups, the median (inter-quartile range [IQR]) age was 61 (54-71) Corticosteroid exposure increased with the severity of COVID-19 pneumonia. Pulsed dose steroids were used more frequently in patients receiving greater respiratory support. Future studies should address patient selection and outcomes associated with pulsed dose steroids in patients with severe and deteriorating COVID-19 pneumonia.
Sections du résumé
Background
UNASSIGNED
Corticosteroids are used to treat COVID-19 pneumonia. However, the optimal dose is unclear. This study describes the association between corticosteroid exposure with disease severity and outcome in COVID-19 pneumonia.
Methods
UNASSIGNED
This is a single-centre retrospective, observational study including adult ICU patients who received systemic corticosteroids for COVID-19 pneumonia between March 2020 and March 2021. We recorded patient characteristics, disease severity, total steroid exposure, respiratory support and gas exchange data, and 90-day mortality.
Results
UNASSIGNED
We included 362 patients. We allocated patients to groups with increasing disease severity according to the highest level of respiratory support that they received: high-flow nasal oxygen or continuous positive airway pressure (HFNO/CPAP) in 12.7%, invasive mechanical ventilation (IMV) in 61.6%, and extracorporeal membrane oxygenation (ECMO) in 25.7%. For these three groups, the median (inter-quartile range [IQR]) age was 61 (54-71)
Conclusions
UNASSIGNED
Corticosteroid exposure increased with the severity of COVID-19 pneumonia. Pulsed dose steroids were used more frequently in patients receiving greater respiratory support. Future studies should address patient selection and outcomes associated with pulsed dose steroids in patients with severe and deteriorating COVID-19 pneumonia.
Identifiants
pubmed: 36744291
doi: 10.1016/j.bjao.2023.100128
pii: S2772-6096(23)00006-0
pmc: PMC9886648
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100128Informations de copyright
© 2023 The Author(s).
Déclaration de conflit d'intérêts
The authors declare they have no conflicts of interest.
Références
N Engl J Med. 2021 Feb 25;384(8):693-704
pubmed: 32678530
Mod Pathol. 2020 Nov;33(11):2128-2138
pubmed: 32572155
J Med Virol. 2020 Jul;92(7):856-862
pubmed: 32281668
Open Forum Infect Dis. 2020 Apr 29;7(5):ofaa153
pubmed: 32455147
JAMA. 2020 Oct 6;324(13):1307-1316
pubmed: 32876695
JAMA. 2020 Oct 6;324(13):1330-1341
pubmed: 32876694
J Cardiothorac Vasc Anesth. 2022 Sep;36(9):3576-3586
pubmed: 35715291
JAMA. 2021 Nov 9;326(18):1807-1817
pubmed: 34673895
N Engl J Med. 2006 Apr 20;354(16):1671-84
pubmed: 16625008
Chest. 2007 Apr;131(4):954-63
pubmed: 17426195
Eur Respir J. 2020 Dec 24;56(6):
pubmed: 32943404
J Intensive Care. 2018 Aug 24;6:53
pubmed: 30155260
Intensive Care Med. 2020 Aug;46(8):1603-1606
pubmed: 32415314
Intensive Care Med. 2022 Jan;48(1):45-55
pubmed: 34757439
Clin Infect Dis. 2020 Apr 27;:
pubmed: 32338708
Diagn Interv Radiol. 2020 Jul;26(4):323-332
pubmed: 32352917
Crit Care Med. 2017 Dec;45(12):2078-2088
pubmed: 28938253
Thorax. 2000 Apr;55(4):318-28
pubmed: 10722773
Intensive Care Med. 2020 Jun;46(6):1089-1098
pubmed: 32367170
Lancet Respir Med. 2020 Mar;8(3):267-276
pubmed: 32043986
Crit Care Med. 2018 Jun;46(6):884-891
pubmed: 29432350
Clin Pharmacokinet. 2005;44(1):61-98
pubmed: 15634032
EBioMedicine. 2022 Sep;83:104229
pubmed: 36027872
Am J Med. 1977 Aug;63(2):200-7
pubmed: 888843
Eur Respir J. 2022 Oct 20;60(4):
pubmed: 35361632
Eur J Clin Microbiol Infect Dis. 2021 Apr;40(4):761-769
pubmed: 33083917