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Urbina T, Gabarre P, Bonny V, Lavillegrand JR, Garnier M, Joffre J, Mario N, Dumas G, Hariri G, Turpin M, Pardo E, Fartoukh M, Guidet B, Maury E, Chantran Y, Boelle PY, Voiriot G, Ait-Oufella H. Corticosteroids induce an early but limited decrease in IL-6 dependent pro-inflammatory responses in critically ill COVID-19 patients. Minerva Anestesiol 2024; 90:172-180. [PMID: 38287776 DOI: 10.23736/s0375-9393.23.17765-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
BACKGROUND Corticosteroids have become standard of care for COVID-19 but their effect on the systemic immune-inflammatory response has been little investigated. METHODS Multicenter prospective cohort, including critically ill COVID-19 patients between March and November 2020. C-reactive protein (CRP), lymphocyte count and fibrinogen levels were collected upon hospital admission before initiation of steroid treatment and at ICU admission, three days and seven days later, along with interleukin (IL)-6, IL-10 and tumor necrosis factor-alpha (TNF-α) plasma levels. RESULTS A hundred and fifty patients were included, 47 received corticosteroids, 103 did not. Median age was 62 [53-70], and 96 (65%) patients were mechanically ventilated. Propensity score matching rendered 45 well-balanced pairs of treated and non-treated patients, particularly on pre-treatment CRP levels. Using a mixed model, CRP (P=0.019), fibrinogen (P=0.003) and lymphocyte counts (P=0.006) remained lower in treated patients over ICU stay. Conversely, there was no significant difference over the ICU stay for Il-6 (P=0.146) and IL-10 (0.301), while TNF- α levels were higher in the treated group (P=0.013). Among corticosteroid-treated patients, CRP (P=0.012), fibrinogen (P=0.041) and lymphocyte count (P=0.004) over time were associated with outcome, whereas plasma cytokine levels were not. CONCLUSIONS Steroid treatment was associated with an early and sustained decrease in the downstream IL-6-dependent inflammatory signature but an increase in TNF-α levels. In corticosteroid-treated patients, CRP and lymphocyte count were associated with outcome, conversely to plasma cytokine levels. Further research on using these biomarker's kinetics to individualize immunomodulatory treatments is warranted.
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Affiliation(s)
- Tomas Urbina
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France -
| | - Paul Gabarre
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Vincent Bonny
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Jean-Rémi Lavillegrand
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Marc Garnier
- Sorbonne University, Faculty of Medicine, Paris, France
- Anesthesiology and Critical Care Medicine Department, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Jérémie Joffre
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Nathalie Mario
- Department of Biochemistry, Hormonology and Therapeutic Follow-Up, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Guillaume Dumas
- Intensive Care Unit, Saint-Louis Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Geoffroy Hariri
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Matthieu Turpin
- Sorbonne University, Faculty of Medicine, Paris, France
- Intensive Care Unit, Tenon Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Emmanuel Pardo
- Anesthesiology and Critical Care Medicine Department, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Muriel Fartoukh
- Sorbonne University, Faculty of Medicine, Paris, France
- Intensive Care Unit, Tenon Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Bertrand Guidet
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Eric Maury
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Yannick Chantran
- Department of Biological Immunology, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Pierre-Yves Boelle
- INSERM, Sorbonne University, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Guillaume Voiriot
- Sorbonne University, Faculty of Medicine, Paris, France
- Intensive Care Unit, Tenon Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Hafid Ait-Oufella
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
- Inserm U970, Cardiovascular Research Center, University of Paris, Paris, France
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Taher A, Lashkari M, Keramat F, Hashemi SH, Sedighi L, Poorolajal J, Mehrpooya M. Comparison of the efficacy of equivalent doses of dexamethasone, methylprednisolone, and hydrocortisone for treatment of COVID-19-related acute respiratory distress syndrome: a prospective three-arm randomized clinical trial. Wien Med Wochenschr 2023; 173:140-151. [PMID: 36624180 PMCID: PMC9838299 DOI: 10.1007/s10354-022-00993-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/24/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND This prospective controlled clinical trial aimed to compare the efficacy of methylprednisolone, dexamethasone, and hydrocortisone at equivalent doses in patients with severe COVID-19. METHODS In total, 106 patients with mild to moderate COVID-19-related acute respiratory distress syndrome (ARDS) were randomized to receive either dexamethasone (6 mg once a day), methylprednisolone (16 mg twice a day), or hydrocortisone (50 mg thrice a day) for up to 10 days. All participants received a standard of care for COVID-19. The primary and secondary efficacy outcomes included all-cause 28-day mortality, clinical status on day 28 assessed using the World Health Organization (WHO) eight-category ordinal clinical scale, number of patients requiring mechanical ventilation and intensive care unit (ICU) care, number of ventilator-free days, length of hospital and ICU stay, change in PaO2:FiO2 ratios during the first 5 days after treatment, and incidence of serious adverse events. P-values below 0.008 based on Bonferroni's multiple-testing correction method were considered statistically significant. RESULTS According to the obtained results, there was a trend toward more favorable clinical outcomes in terms of needing mechanical ventilation and ICU care, number of ventilator-free days, change in PaO2:FiO2 ratios during the first 5 days after treatment, clinical status score at day 28, length of ICU and hospital stay, and overall 28-day mortality in patients receiving dexamethasone compared to those receiving methylprednisolone or hydrocortisone; however, likely due to the study's small sample size, the difference between groups reached a significant level only in the case of clinical status score on day 28 (p-value = 0.003). There was no significant difference in the incidence of serious adverse events between the study groups. CONCLUSION Based on the results, severe cases of COVID-19 treated with dexamethasone might have a better clinical status at 28-day follow-up compared to methylprednisolone and hydrocortisone at an equivalent dose. Larger multicenter trials are required to confirm our findings.
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Affiliation(s)
- Abbas Taher
- Department of Anesthesiology and Critical Care, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Marjan Lashkari
- Department of Anesthesiology and Critical Care, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fariba Keramat
- Department Infectious Disease, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyyed Hamid Hashemi
- Department Infectious Disease, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ladan Sedighi
- Department of medical and surgical nursing, school of nursing and midwifery, Shahid Beheshti university of Medical Sciences, Tehran, Iran
| | - Jalal Poorolajal
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Mehrpooya
- Department of Clinical Pharmacy, School of Pharmacy, Medicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Shahid Fahmideh Ave, 6517838678 Hamadan, Iran
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