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Methylprednisolone and 60 Days in Hospital Survival in Coronavirus Disease 2019 Pneumonia.
Crit Care Explor. 2021 Jul; 3(7):e0493.CC

Abstract

OBJECTIVES

To determine methylprednisolone's dose, duration, and administration from onset of symptoms and association with 60 days in hospital survival of coronavirus disease 2019 pneumonia.

DESIGN

Cohort study.

SETTING

Thirteen hospitals in New Jersey, United States during March to June 2020.

PATIENTS

Seven-hundred fifty-nine hospitalized coronavirus disease 2019 patients.

INTERVENTIONS

We performed a propensity matched cohort study between patients who received methylprednisolone and no methylprednisolone. Patients in the methylprednisolone group were further differentiated into dose (high dose and low dose), duration, and administration from onset of symptoms.

MEASUREMENTS AND MAIN RESULTS

In the propensity matched sample, 99 out of 380 (26%) in no methylprednisolone, 69 out of 215 (31.9%) in low-dose methylprednisolone, and 74 out of 164 (55.2%) high-dose methylprednisolone expired. Overall median survival for no methylprednisolone (25.0 d), low-dose methylprednisolone (39.0 d), high-dose methylprednisolone (20.0 d), less than or equal to 7 days duration (19.0 d), 7-14 days duration (30.0 d), greater than 14 days duration (44.0 d), onset of symptoms less than or equal to 7 days (20.0 d), and onset of symptoms 7-14 days (27.0 d) were statistically significant (log-rank p ≤ 0.001). Multivariate Cox regression showed nursing home residents, coronary artery disease, and invasive mechanical ventilation were independently associated with mortality. Methylprednisolone was associated with reduced mortality compared with no methylprednisolone (hazard ratio, 0.40; 95% CI, 0.27-0.59; p < 0.001) but no added benefit with high dose. Low-dose methylprednisolone for 7-14 days was associated with reduced mortality compared with less than or equal to 7 days (hazard ratio, 0.45; 95% CI, 0.22-0.91; p = 0.0273), and no additional benefit if greater than 14 days (hazard ratio, 1.27; 95% CI, 0.60-2.69; p = 0.5434). Combination therapy with tocilizumab was associated with reduced mortality over monotherapy (p < 0.0116).

CONCLUSIONS

Low-dose methylprednisolone was associated with reduced mortality if given greater than 7 days from onset of symptoms, and no additional benefit greater than 14 days. High dose was associated with higher mortality.

Authors+Show Affiliations

Hackensack Meridian School of Medicine, Nutley, NJ. Division of Pulmonary, Critical Care and Sleep Medicine, Hackensack University Medical Center, Hackensack, NJ.Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.Hackensack Meridian School of Medicine, Nutley, NJ. Office of Research Administration, Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, NJ.Division of Pulmonary, Critical Care, Allergy and Rheumatology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ.Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.JTCC Applications, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ.Hackensack Meridian School of Medicine, Nutley, NJ. Division of Pulmonary, Critical Care and Sleep Medicine, Hackensack University Medical Center, Hackensack, NJ. Division of Infectious Disease, Hackensack Meridian School of Medicine, Hackensack University Medical Center, Hackensack, NJ.Hackensack Meridian School of Medicine, Nutley, NJ. Division of Pulmonary, Critical Care and Sleep Medicine, Hackensack University Medical Center, Hackensack, NJ.Hackensack Meridian School of Medicine, Nutley, NJ. Division of Pulmonary, Critical Care and Sleep Medicine, Hackensack University Medical Center, Hackensack, NJ.Hackensack Meridian School of Medicine, Nutley, NJ. Division of Pulmonary, Critical Care and Sleep Medicine, Hackensack University Medical Center, Hackensack, NJ.Hackensack Meridian School of Medicine, Nutley, NJ. Division of Infectious Disease, Hackensack Meridian School of Medicine, Hackensack University Medical Center, Hackensack, NJ.Hackensack Meridian School of Medicine, Nutley, NJ. Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34291223

Citation

Go, Ronaldo C., et al. "Methylprednisolone and 60 Days in Hospital Survival in Coronavirus Disease 2019 Pneumonia." Critical Care Explorations, vol. 3, no. 7, 2021, pp. e0493.
Go RC, Shah R, Nyirenda T, et al. Methylprednisolone and 60 Days in Hospital Survival in Coronavirus Disease 2019 Pneumonia. Crit Care Explor. 2021;3(7):e0493.
Go, R. C., Shah, R., Nyirenda, T., Oe, Y., Sarfraz, K., Panthappattu, J. J., Philip, L., Bheeman, C., Shah, N., Shah, S., Dar, S., Hung, S., Rahman, W., Im, H., Marafelias, M., Omidvari, K., Pradhan, A., Sadikot, S., Rose, K. M., ... Josephs, J. (2021). Methylprednisolone and 60 Days in Hospital Survival in Coronavirus Disease 2019 Pneumonia. Critical Care Explorations, 3(7), e0493. https://doi.org/10.1097/CCE.0000000000000493
Go RC, et al. Methylprednisolone and 60 Days in Hospital Survival in Coronavirus Disease 2019 Pneumonia. Crit Care Explor. 2021;3(7):e0493. PubMed PMID: 34291223.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Methylprednisolone and 60 Days in Hospital Survival in Coronavirus Disease 2019 Pneumonia. AU - Go,Ronaldo C, AU - Shah,Roshan, AU - Nyirenda,Themba, AU - Oe,Yukiko, AU - Sarfraz,Khurram, AU - Panthappattu,Justin J, AU - Philip,Lesley, AU - Bheeman,Chandni, AU - Shah,Neel, AU - Shah,Sapan, AU - Dar,Sophia, AU - Hung,Sung, AU - Rahman,Waqas, AU - Im,Hyun, AU - Marafelias,Michael, AU - Omidvari,Karan, AU - Pradhan,Anuja, AU - Sadikot,Sean, AU - Rose,Keith M, AU - Sperber,Steven J, AU - Josephs,Joshua, Y1 - 2021/07/19/ PY - 2021/7/22/entrez PY - 2021/7/23/pubmed PY - 2021/7/23/medline KW - acute respiratory distress syndrome KW - coronavirus disease 2019 KW - methylprednisolone KW - pneumonia SP - e0493 EP - e0493 JF - Critical care explorations JO - Crit Care Explor VL - 3 IS - 7 N2 - OBJECTIVES: To determine methylprednisolone's dose, duration, and administration from onset of symptoms and association with 60 days in hospital survival of coronavirus disease 2019 pneumonia. DESIGN: Cohort study. SETTING: Thirteen hospitals in New Jersey, United States during March to June 2020. PATIENTS: Seven-hundred fifty-nine hospitalized coronavirus disease 2019 patients. INTERVENTIONS: We performed a propensity matched cohort study between patients who received methylprednisolone and no methylprednisolone. Patients in the methylprednisolone group were further differentiated into dose (high dose and low dose), duration, and administration from onset of symptoms. MEASUREMENTS AND MAIN RESULTS: In the propensity matched sample, 99 out of 380 (26%) in no methylprednisolone, 69 out of 215 (31.9%) in low-dose methylprednisolone, and 74 out of 164 (55.2%) high-dose methylprednisolone expired. Overall median survival for no methylprednisolone (25.0 d), low-dose methylprednisolone (39.0 d), high-dose methylprednisolone (20.0 d), less than or equal to 7 days duration (19.0 d), 7-14 days duration (30.0 d), greater than 14 days duration (44.0 d), onset of symptoms less than or equal to 7 days (20.0 d), and onset of symptoms 7-14 days (27.0 d) were statistically significant (log-rank p ≤ 0.001). Multivariate Cox regression showed nursing home residents, coronary artery disease, and invasive mechanical ventilation were independently associated with mortality. Methylprednisolone was associated with reduced mortality compared with no methylprednisolone (hazard ratio, 0.40; 95% CI, 0.27-0.59; p < 0.001) but no added benefit with high dose. Low-dose methylprednisolone for 7-14 days was associated with reduced mortality compared with less than or equal to 7 days (hazard ratio, 0.45; 95% CI, 0.22-0.91; p = 0.0273), and no additional benefit if greater than 14 days (hazard ratio, 1.27; 95% CI, 0.60-2.69; p = 0.5434). Combination therapy with tocilizumab was associated with reduced mortality over monotherapy (p < 0.0116). CONCLUSIONS: Low-dose methylprednisolone was associated with reduced mortality if given greater than 7 days from onset of symptoms, and no additional benefit greater than 14 days. High dose was associated with higher mortality. SN - 2639-8028 UR - https://www.unboundmedicine.com/medline/citation/34291223/Methylprednisolone_and_60_Days_in_Hospital_Survival_in_Coronavirus_Disease_2019_Pneumonia. L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=34291223.ui DB - PRIME DP - Unbound Medicine ER -