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- Title
Use of glucocorticoids megadoses in SARS-CoV-2 infection in a spanish registry: SEMI-COVID-19.
- Authors
Lavilla Olleros, Cristina; Ausín García, Cristina; Bendala Estrada, Alejandro David; Muñoz, Ana; Wikman Jogersen, Philip Erick; Fernández Cruz, Ana; Giner Galvañ, Vicente; Vargas, Juan Antonio; Seguí Ripoll, José Miguel; Rubio-Rivas, Manuel; Miranda Godoy, Rodrigo; Mérida Rodrigo, Luis; Fonseca Aizpuru, Eva; Arnalich Fernández, Francisco; Artero, Arturo; Loureiro Amigo, Jose; García García, Gema María; Corral Gudino, Luis; Jiménez Torres, Jose; Casas-Rojo, José-Manuel
- Abstract
Objective: To describe the impact of different doses of corticosteroids on the evolution of patients with COVID-19 pneumonia, based on the potential benefit of the non-genomic mechanism of these drugs at higher doses. Methods: Observational study using data collected from the SEMI-COVID-19 Registry. We evaluated the epidemiological, radiological and analytical scenario between patients treated with megadoses therapy of corticosteroids vs low-dose of corticosteroids and the development of complications. The primary endpoint was all-cause in-hospital mortality according to use of corticosteroids megadoses. Results: Of a total of 14,921 patients, corticosteroids were used in 5,262 (35.3%). Of them, 2,216 (46%) specifically received megadoses. Age was a factor that differed between those who received megadoses therapy versus those who did not in a significant manner (69 years [IQR 59–79] vs 73 years [IQR 61–83]; p <.001). Radiological and analytical findings showed a higher use of megadoses therapy among patients with an interstitial infiltrate and elevated inflammatory markers associated with COVID-19. In the univariate study it appears that steroid use is associated with increased mortality (OR 2.07 95% CI 1.91–2.24 p <.001) and megadose use with increased survival (OR 0.84 95% CI 0.75–0.96, p 0.011), but when adjusting for possible confounding factors, it is observed that the use of megadoses is also associated with higher mortality (OR 1.54, 95% CI 1.32–1.80; p <.001). There is no difference between megadoses and low-dose (p.298). Although, there are differences in the use of megadoses versus low-dose in terms of complications, mainly infectious, with fewer pneumonias and sepsis in the megadoses group (OR 0.82 95% CI 0.71–0.95; p <.001 and OR 0.80 95% CI 0.65–0.97; p <.001) respectively. Conclusion: There is no difference in mortality with megadoses versus low-dose, but there is a lower incidence of infectious complications with glucocorticoid megadoses.
- Subjects
SARS-CoV-2; HOSPITAL mortality; GLUCOCORTICOIDS; COVID-19; STEROID drugs; KLEBSIELLA infections
- Publication
PLoS ONE, 2022, Vol 17, Issue 1, p1
- ISSN
1932-6203
- Publication type
Article
- DOI
10.1371/journal.pone.0261711