Steroids in severe COVID-19 patients: A retrospective analysis on the first pandemics in Lombardy
Open Access
- 21 September 2021
- journal article
- research article
- Published by PAGEPress Publications in Emergency Care Journal
- Vol. 17 (3)
- https://doi.org/10.4081/ecj.2021.9888
Abstract
The pathogenesis of COVID-19 appears to be characterized by a dysregulated immune response. During the first pandemic wave in Lombardy, we started to administer glucocorticoids to some patients with severe respiratory failure requiring support with Continuous Positive Airway Pressure (CPAP) therapy. We retrospectively collected data to identify the effect of glucocorticoids in this COVID-19 particular population. With a multidisciplinary consensus, we administered to selected patients with severe COVID-19 disease (PaO2/FiO2 159±71 mmHg) 0,91 mg/kg/die of methylprednisolone equivalent dose after a median of 8 days of hospitalization. In our study we compared 57 patients from the steroid group with 123 from the control group: the event of invasive mechanical ventilation or death was reduced by 43% between steroid group and control group (19.3 % vs. 34.1 % respectively, p=0.001) and mortality was reduced by about 31% between steroid and usual care alone (15.8 % vs. 22.8 % respectively, p=0.011). Corticosteroids in selected COVID-19 patients may have a relevant impact on outcome, better profiling of the heterogeneity of this disease may be essential to guarantee the best treatment choices.Keywords
This publication has 38 references indexed in Scilit:
- Clinical and immunological features of severe and moderate coronavirus disease 2019JCI Insight, 2020
- COVID-19 illness in native and immunosuppressed states: A clinical–therapeutic staging proposalThe Journal of Heart and Lung Transplantation, 2020
- Changing Emergency Department and hospital organization in response to a changing epidemicEmergency Care Journal, 2020
- On the use of corticosteroids for 2019-nCoV pneumoniaThe Lancet, 2020
- Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injuryThe Lancet, 2020
- Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trialThe Lancet Respiratory Medicine, 2020
- Prolonged low-dose methylprednisolone treatment is highly effective in reducing duration of mechanical ventilation and mortality in patients with ARDSJournal of Intensive Care, 2018
- Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017Intensive Care Medicine, 2017
- The clinical practice guideline for the management of ARDS in JapanJournal of Intensive Care, 2017
- Corticosteroid pharmacokinetic abnormalities in overweight and obese corticosteroid resistant asthmaticsThe Journal of Allergy and Clinical Immunology: In Practice, 2016