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High-dose corticosteroids in patients hospitalized for COVID-19 pneumonia: an observational study of comparative effectiveness.
Langer-Gould, Annette; Xu, Stanley; Myers, Laura C; Chen, Aiyu; Greene, John D; Creekmur, Beth; Bruxvoort, Katia; Adams, John L; Liu, Vincent; Gould, Michael K.
Afiliación
  • Langer-Gould A; Southern California Permanente Medical Group, Neurology Department, Kaiser Permanente Southern California, Los Angeles, USA; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, USA. Electronic address: Annette.M.Langer-Gould@kp.org.
  • Xu S; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA.
  • Myers LC; Division of Research and The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, USA.
  • Chen A; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA.
  • Greene JD; Division of Research and The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, USA.
  • Creekmur B; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA.
  • Bruxvoort K; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA.
  • Adams JL; Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, USA.
  • Liu V; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, USA.
  • Gould MK; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, USA.
Int J Infect Dis ; 125: 184-191, 2022 Dec.
Article en En | MEDLINE | ID: mdl-36404464
OBJECTIVES: To assess whether high- compared with low-dose corticosteroids started upon hospitalization reduce mortality in patients with severe COVID-19 pneumonia or in subgroups stratified by severity of respiratory impairment on admission. METHODS: We conducted a retrospective cohort study of patients with confirmed SARS-CoV-2 infection who required oxygen supplementation upon hospitalization between March 1 and December 31, 2020. In-hospital death was analyzed using logistic regression with inverse probability of treatment weighting of receiving low- or high-dose corticosteroid (dexamethasone 6-10 mg daily or >10-20 mg daily or other corticosteroid equivalents). RESULTS: We analyzed 13,366 patients who received low-dose and 948 who received high-dose corticosteroids, of whom 31.3% and 40.4% had severe respiratory impairment (>15 l/min of oxygen or mechanical ventilation) upon admission, respectively. There were no differences in the propensity score-adjusted odds of death (odds ratio 1.17, 95% CI 0.72-1.90) or infections (odds ratio 0.70, 95% CI 0.44-1.11) for patients who received high-dose compared with low-dose corticosteroids, beginning on the day of admission. No significant differences in subgroups stratified by severity of respiratory impairment were found. CONCLUSION: Initiating high-dose compared with low-dose corticosteroids among newly hospitalized patients with COVID-19 pneumonia did not improve survival. However, benefit of high-dose corticosteroids in specific subgroups cannot be excluded.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: COVID-19 Tipo de estudio: Observational_studies Límite: Humans Idioma: En Revista: Int J Infect Dis Asunto de la revista: DOENCAS TRANSMISSIVEIS Año: 2022 Tipo del documento: Article Pais de publicación: Canadá
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: COVID-19 Tipo de estudio: Observational_studies Límite: Humans Idioma: En Revista: Int J Infect Dis Asunto de la revista: DOENCAS TRANSMISSIVEIS Año: 2022 Tipo del documento: Article Pais de publicación: Canadá