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Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis.
Crit Care. 2020 11 10; 24(1):643.CC

Abstract

BACKGROUND

The impact of corticosteroid therapy on outcomes of patients with coronavirus disease 2019 (COVID-19) is highly controversial. We aimed to compare the risk of death between COVID-19-related ARDS patients with corticosteroid treatment and those without.

METHODS

In this single-center retrospective observational study, patients with ARDS caused by COVID-19 between January 20, 2020, and February 24, 2020, were enrolled. The primary outcome was 60-day in-hospital death. The exposure was prescribed systemic corticosteroids or not. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for 60-day in-hospital mortality.

RESULTS

A total of 382 patients [60.7 ± 14.1 years old (mean ± SD), 61.3% males] were analyzed. The median of sequential organ failure assessment (SOFA) score was 2.0 (IQR 2.0-3.0). Of these cases, 94 (24.6%) patients had invasive mechanical ventilation. The number of patients received systemic corticosteroids was 226 (59.2%), and 156 (40.8%) received standard treatment. The maximum dose of corticosteroids was 80.0 (IQR 40.0-80.0) mg equivalent methylprednisolone per day, and duration of corticosteroid treatment was 7.0 (4.0-12.0) days in total. In Cox regression analysis using corticosteroid treatment as a time-varying variable, corticosteroid treatment was associated with a significant reduction in risk of in-hospital death within 60 days after adjusting for age, sex, SOFA score at hospital admission, propensity score of corticosteroid treatment, comorbidities, antiviral treatment, and respiratory supports (HR 0.42; 95% CI 0.21, 0.85; p = 0.0160). Corticosteroids were not associated with delayed viral RNA clearance in our cohort.

CONCLUSION

In this clinical practice setting, low-dose corticosteroid treatment was associated with reduced risk of in-hospital death within 60 days in COVID-19 patients who developed ARDS.

Authors+Show Affiliations

Department of Pulmonary and Critical Care Medicine, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China. Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.Department of Pulmonary and Critical Care Medicine, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.Infection Division, Wuhan Jin Yin-Tan Hospital, Wuhan, China.Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.Department of Infectious Diseases, Fengxian Guhua Hospital, Shanghai, China.Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.Department of Gastroenterology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.Department of Respiratory and Critical Care Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.Department of Pulmonary Medicine, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Shanghai, China.Department of Pulmonary and Critical Care Medicine, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China. ylsong70@163.com. Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China. ylsong70@163.com. Shanghai Respiratory Research Institute, Shanghai, China. ylsong70@163.com. National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China. ylsong70@163.com. Jinshan Hospital of Fudan University, Shanghai, China. ylsong70@163.com.Infection Division, Wuhan Jin Yin-Tan Hospital, Wuhan, China. gfy.yuyingzi@163.com.

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33172477

Citation

Wu, Chaomin, et al. "Corticosteroid Therapy for Coronavirus Disease 2019-related Acute Respiratory Distress Syndrome: a Cohort Study With Propensity Score Analysis." Critical Care (London, England), vol. 24, no. 1, 2020, p. 643.
Wu C, Hou D, Du C, et al. Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis. Crit Care. 2020;24(1):643.
Wu, C., Hou, D., Du, C., Cai, Y., Zheng, J., Xu, J., Chen, X., Chen, C., Hu, X., Zhang, Y., Song, J., Wang, L., Chao, Y. C., Feng, Y., Xiong, W., Chen, D., Zhong, M., Hu, J., Jiang, J., ... Gong, F. (2020). Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis. Critical Care (London, England), 24(1), 643. https://doi.org/10.1186/s13054-020-03340-4
Wu C, et al. Corticosteroid Therapy for Coronavirus Disease 2019-related Acute Respiratory Distress Syndrome: a Cohort Study With Propensity Score Analysis. Crit Care. 2020 11 10;24(1):643. PubMed PMID: 33172477.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis. AU - Wu,Chaomin, AU - Hou,Dongni, AU - Du,Chunling, AU - Cai,Yanping, AU - Zheng,Junhua, AU - Xu,Jie, AU - Chen,Xiaoyan, AU - Chen,Cuicui, AU - Hu,Xianglin, AU - Zhang,Yuye, AU - Song,Juan, AU - Wang,Lu, AU - Chao,Yen-Cheng, AU - Feng,Yun, AU - Xiong,Weining, AU - Chen,Dechang, AU - Zhong,Ming, AU - Hu,Jie, AU - Jiang,Jinjun, AU - Bai,Chunxue, AU - Zhou,Xin, AU - Xu,Jinfu, AU - Song,Yuanlin, AU - Gong,Fengyun, Y1 - 2020/11/10/ PY - 2020/07/24/received PY - 2020/10/11/accepted PY - 2020/11/11/entrez PY - 2020/11/12/pubmed PY - 2020/11/26/medline KW - Coronavirus disease 2019 KW - Corticosteroids KW - Methylprednisolone KW - Mortality KW - Propensity score KW - Severe acute respiratory syndrome coronavirus 2 SP - 643 EP - 643 JF - Critical care (London, England) JO - Crit Care VL - 24 IS - 1 N2 - BACKGROUND: The impact of corticosteroid therapy on outcomes of patients with coronavirus disease 2019 (COVID-19) is highly controversial. We aimed to compare the risk of death between COVID-19-related ARDS patients with corticosteroid treatment and those without. METHODS: In this single-center retrospective observational study, patients with ARDS caused by COVID-19 between January 20, 2020, and February 24, 2020, were enrolled. The primary outcome was 60-day in-hospital death. The exposure was prescribed systemic corticosteroids or not. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for 60-day in-hospital mortality. RESULTS: A total of 382 patients [60.7 ± 14.1 years old (mean ± SD), 61.3% males] were analyzed. The median of sequential organ failure assessment (SOFA) score was 2.0 (IQR 2.0-3.0). Of these cases, 94 (24.6%) patients had invasive mechanical ventilation. The number of patients received systemic corticosteroids was 226 (59.2%), and 156 (40.8%) received standard treatment. The maximum dose of corticosteroids was 80.0 (IQR 40.0-80.0) mg equivalent methylprednisolone per day, and duration of corticosteroid treatment was 7.0 (4.0-12.0) days in total. In Cox regression analysis using corticosteroid treatment as a time-varying variable, corticosteroid treatment was associated with a significant reduction in risk of in-hospital death within 60 days after adjusting for age, sex, SOFA score at hospital admission, propensity score of corticosteroid treatment, comorbidities, antiviral treatment, and respiratory supports (HR 0.42; 95% CI 0.21, 0.85; p = 0.0160). Corticosteroids were not associated with delayed viral RNA clearance in our cohort. CONCLUSION: In this clinical practice setting, low-dose corticosteroid treatment was associated with reduced risk of in-hospital death within 60 days in COVID-19 patients who developed ARDS. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/33172477/Corticosteroid_therapy_for_coronavirus_disease_2019_related_acute_respiratory_distress_syndrome:_a_cohort_study_with_propensity_score_analysis_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03340-4 DB - PRIME DP - Unbound Medicine ER -