CMAAO Coronavirus Facts and Myth Buster: Early Steroids |
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CMAAO Coronavirus Facts and Myth Buster: Early Steroids
Dr KK Aggarwal,  14 September 2020
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With input from Dr Monica Vasudev

Corticosteroid use tied to lower risk of condition worsening in non-ICU patients with COVID-19 pneumonia

  1. A study published in PLOS ONEhas revealed that early use of moderate-dose systemic corticosteroids in patients admitted to the general ward with COVID-19 pneumonia complicated by acute hypoxic respiratory failure (AHRF) resulted in a significantly lower rate of the primary composite outcome of ICU transfer, intubation, or in-hospital death.
  2. The single-center retrospective cohort study assessed 265 patients consecutively admitted to non-ICU wards with laboratory-confirmed COVID-19 pneumonia between March 16 and April 30, 2020.
  3. Overall, 205 patients who developed AHRF (SpO2/FiO2≤ 440 or PaO2/FiO2 ≤ 300) were included in the final study.
  4. The mean age of the patients was 57 years; 74.63% were male, 73.04% patients were of Hispanic ethnicity/race. Among these 205 patients, 29.27% received systemic corticosteroids.
  5. Patients received methylprednisolone (n = 29, 48.33%), prednisone (n = 10, 16.67%), hydrocortisone (n = 1, 1.67%), and dexamethasone (n = 20, 33.33%).
  6. Corticosteroid treatment was started at a median of 2 days (IQR, 1–5) following admission, on a median or equivalent dose of 80 mg/day (IQR, 60–107) of methylprednisolone (equivalent to 12 (IQR, 9–16) mg of dexamethasone) for a median duration of 5 days (IQR, 4–7).
  7. Among the 202 eligible patients, 13 (22.41%) patients in the corticosteroid cohort developed the primary composite outcome, compared to 54 (37.5%) patients in the non-corticosteroid group (P = 0.039). The adjusted hazard ratio (HR) for developing the composite primary outcome was 0.15 (95% CI, 0.07–0.33; P <0.001).
  8. Early administration of moderate-dose systemic corticosteroid (oral or intravenous) for a shorter duration in COVID-19 viral pneumonia may not be as harmful as initially believed. Additionally, it may be more beneficial than shown by the RECOVERY trial, whose early results revealed that low-dose (6 mg) dexamethasone decreased the risk of death among COVID-19 patients who required oxygen, with or without invasive mechanical ventilation.

[PLOS One]

 

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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