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Impact of intermediate to high doses of methylprednisolone on mortality rate in patients with COVID‐19 pneumonia‐induced severe systemic inflammation

2021; Wiley; Volume: 75; Issue: 9 Linguagem: Inglês

10.1111/ijcp.14479

1742-1241

Mónica Climente‐Martí, Oreto Ruiz‐Millo, Ian López‐Cruz, Ángel Atienza‐García, Eva Martínez‐Moragón, Emilio Garijo‐Gómez, María Luisa López‐Grima, Rafael Zaragoza‐Crespo, Juan Vicente Llau‐Pitarch, Daniel Bautista‐Rentero, José Miguel Nogueira‐Coito, Tomás Ripollés‐González, María Antonia Marco‐Artal, Ramón Romero‐Serrano, Francisco Dolz‐Sinisterra, Rosario López‐Estudillo, Marta Acosta‐Dávila, Juan Alberola, Ulises Alfredo‐López, Cristina Álvarez‐Herreros, Rocío Armero‐Ibáñez, Ángel Atienza‐García, Daniel Bautista‐Rentero, Alberto Berenguer‐Muncharaz, Carmen Borraz‐Ordás, Sergio Calvache‐Castillo, Juan José Camarena‐Miñana, Mar Carmona‐Martín, Daniel Castelló‐García, Mónica Climente‐Martí, Francisco Dolz‐Sinisterra, Maria José Fabiá‐Valls, Emilio Garijo‐Gómez, Cristina Pilar Giménez‐Lozano, Rosa María González-Pellicer, Héctor Hernández Garcés, Ignacio Inchaurraga‐Álvarez, Maria Ángeles Juan‐Gómez, Juan Vicente Llau‐Pitarch, Ian López‐Cruz, Rosario López‐Estudillo, María Luisa López‐Grima, María Antonia Marco‐Artal, Ángel Marcos‐Fendián, Eva Martínez‐Moragón, Ana Míguez‐Santiyán, José Miguel Nogueira‐Coito, Martín Parejo‐Montell, Tomás Ripollés‐González, Ramón Romero‐Serrano, Oreto Ruiz‐Millo, Belén Salvador‐Montero, Cyntia Sánchez‐Martín, Azahar Sancho‐Artés, Amparo Valero‐Domènech, Josefina Zaballos‐Bon, Rafael Zaragoza‐Crespo,

Sepsis Diagnosis and Treatment

In addition to respiratory support needs, patients' characteristics to guide indication or timing of corticosteroid treatment in COVID-19 patients are not completely established. This study aimed to evaluate the impact of methylprednisolone on mortality rate in patients with COVID-19 pneumonia-induced severe systemic inflammation (PI-SSI).Between 9 March and 5 May 2020 (final follow-up on 2 July 2020), a retrospective cohort study was conducted in hospitalised patients with COVID-19 PI-SSI (≥2 inflammatory biomarkers [IBs]: temperature ≥38℃, lymphocyte ≤800 cell/µL, C-reactive protein ≥100 mg/L, lactate dehydrogenase ≥300 units/L, ferritin ≥1000 mcg/L, D-dimer ≥500 ng/mL). Patients received 0.5-1.0 mg/kg of methylprednisolone for 5-10 days or standard of care. The primary outcome was 28-day all-cause mortality. Secondary outcomes included ≥2 points improvement on a 7-item WHO-scale (Day 14), transfer to intensive care unit (ICU) (Day 28) and adverse effects. Kaplan-Meier method and Cox proportional hazard regression were implemented to analyse the time to event outcomes.A total of 142 patients (corticosteroid group n = 72, control group n = 70) were included. A significant reduction in 28-day all-cause mortality was shown with methylprednisolone in patients with respiratory support (HR: 0.15; 95% CI 0.03-0.71), with ≥3 (HR: 0.17; 95% CI 0.05-0.61) or ≥4 altered IB (HR: 0.15; 95% CI 0.04-0.54) and in patients with both respiratory support and ≥3 (HR: 0.11; 95% CI 0.02-0.53] or ≥4 altered IB (HR: 0.14; 95% CI 0.04-0.51). No significant differences were found in secondary outcomes.Intermediate to high doses of methylprednisolone, initiated between 5 and 12 days after symptom onset, was associated with a significant reduction in 28-day all-cause mortality in patients with COVID-19 pneumonia and ≥3 o ≥ 4 altered IB, independently of the need of respiratory support.