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Özşahin A, Ilgar T, Mahmutoğlu Çolak S, Akyüz K, Gözükara MG, Kostakoğlu U, Yildiz İE, Ertürk A. The sharp edge of immunosuppressive treatments: infections. Turk J Med Sci 2024; 54:752-760. [PMID: 39295623 PMCID: PMC11407327 DOI: 10.55730/1300-0144.5845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 08/23/2024] [Accepted: 05/07/2024] [Indexed: 09/21/2024] Open
Abstract
Background and aim Different side effects, including infections, are encountered in patients receiving anticytokines used for the treatment of severe coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the infections and the effects of these infections that develop in this patient group. Materials and Methods This study included 208 patients who were followed-up with the diagnosis of severe COVID-19 in two different hospitals. Patient data were obtained retrospectively from the hospital information system. Results Of the 208 patients included, 54 were in the anakinra group, and 154 were in the tocilizumab group. Of these patients, 73 (35.1%) developed infection, 160 (76.9%) were admitted to the intensive care unit (ICU), and the 30-day mortality rate was 46.6%. The ICU admission, 30-day mortality, and infection rates were higher in the anakinra group, but it was not statistically significant (p = 0.137, p = 0.127, and p = 0.132, respectively), while pneumonia and bloodstream infection (BSI) rates were higher (p = 0.043 and p = 0.010 respectively). The 30-day mortality rate was significantly higher in patients who developed infection, especially in the tocilizumab group (p < 0.001 and p = 0.001). The independent risk factors affecting the development of infection were evaluated via regression analysis, in which it was found that age, sex, and the type of immunosuppressive treatment had no significant effect, while ICU admission increased the risk of infection by 32.8 times (95% CI: 4.4-245.8) and each day of hospitalization slightly increased the risk of infection by 1.06 times (95% CI: 1.03-1.09). Conclusion Infection rates were higher in the anakinra group, especially the pneumonia and BSI rates were higher than in the tocilizumab group. The 30-day mortality rates were higher in patients who had an infection, especially in the tocilizumab group. This is one of the rare studies that evaluated infections developing in patients treated with anakinra and tocilizumab together.
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Affiliation(s)
- Aybegüm Özşahin
- Department of Infectious Diseases and Clinical Microbiology, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkiye
| | - Tuba Ilgar
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkiye
| | - Sudem Mahmutoğlu Çolak
- Department of Infectious Diseases and Clinical Microbiology, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkiye
| | - Kübra Akyüz
- Department of Pulmonary Diseases, Üsküdar State Hospital, İstanbul, Turkiye
| | - Melih Gaffar Gözükara
- Department of Public Health, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkiye
| | - Uğur Kostakoğlu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkiye
| | - İlknur Esen Yildiz
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkiye
| | - Ayşe Ertürk
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkiye
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Verma A, Bhagchandani T, Rai A, Nikita, Sardarni UK, Bhavesh NS, Gulati S, Malik R, Tandon R. Short-Chain Fatty Acid (SCFA) as a Connecting Link between Microbiota and Gut-Lung Axis-A Potential Therapeutic Intervention to Improve Lung Health. ACS OMEGA 2024; 9:14648-14671. [PMID: 38585101 PMCID: PMC10993281 DOI: 10.1021/acsomega.3c05846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 04/09/2024]
Abstract
The microbiome is an integral part of the human gut, and it plays a crucial role in the development of the immune system and homeostasis. Apart from the gut microbiome, the airway microbial community also forms a distinct and crucial part of the human microbiota. Furthermore, several studies indicate the existence of communication between the gut microbiome and their metabolites with the lung airways, called "gut-lung axis". Perturbations in gut microbiota composition, termed dysbiosis, can have acute and chronic effects on the pathophysiology of lung diseases. Microbes and their metabolites in lung stimulate various innate immune pathways, which modulate the expression of the inflammatory genes in pulmonary leukocytes. For instance, gut microbiota-derived metabolites such as short-chain fatty acids can suppress lung inflammation through the activation of G protein-coupled receptors (free fatty acid receptors) and can also inhibit histone deacetylase, which in turn influences the severity of acute and chronic respiratory diseases. Thus, modulation of the gut microbiome composition through probiotic/prebiotic usage and fecal microbiota transplantation can lead to alterations in lung homeostasis and immunity. The resulting manipulation of immune cells function through microbiota and their key metabolites paves the way for the development of novel therapeutic strategies in improving the lung health of individuals affected with various lung diseases including SARS-CoV-2. This review will shed light upon the mechanistic aspect of immune system programming through gut and lung microbiota and exploration of the relationship between gut-lung microbiome and also highlight the therapeutic potential of gut microbiota-derived metabolites in the management of respiratory diseases.
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Affiliation(s)
- Anjali Verma
- Laboratory
of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi 110067, India
| | - Tannu Bhagchandani
- Laboratory
of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi 110067, India
| | - Ankita Rai
- Laboratory
of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi 110067, India
| | - Nikita
- Laboratory
of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi 110067, India
| | - Urvinder Kaur Sardarni
- Laboratory
of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi 110067, India
| | - Neel Sarovar Bhavesh
- Transcription
Regulation Group, International Centre for
Genetic Engineering and Biotechnology (ICGEB), New Delhi 110067, India
| | - Sameer Gulati
- Department
of Medicine, Lady Hardinge Medical College
(LHMC), New Delhi 110058, India
| | - Rupali Malik
- Department
of Medicine, Vardhman Mahavir Medical College
and Safdarjung Hospital, New Delhi 110029, India
| | - Ravi Tandon
- Laboratory
of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi 110067, India
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3
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Lee EP, Lin JJ, Chang HP, Yen CW, Hsieh MS, Chan OW, Lin KL, Su YT, Mu CT, Hsia SH. Ferritin as an Effective Predictor of Neurological Outcomes in Children With Acute Necrotizing Encephalopathy. Pediatr Neurol 2024; 152:162-168. [PMID: 38295717 DOI: 10.1016/j.pediatrneurol.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 04/26/2023] [Accepted: 12/31/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Acute necrotizing encephalopathy (ANE) is a fulminant disease with poor prognosis. Cytokine storm is the important phenomenon of ANE that affects the brain and multiple organs. The study aimed to identify whether hyperferritinemia was associated with poor prognosis in patients with ANE. METHODS All patients with ANE had multiple symmetric lesions located in the bilateral thalami and other regions such as brainstem tegmentum, cerebral white matter, and cerebellum. Neurological outcome at discharge was evaluated by pediatric neurologists using the Pediatric Cerebral Performance Category Scale. All risk factors associated with poor prognosis were further analyzed using receiver operating characteristic curve analysis. RESULTS Twenty-nine patients with ANE were enrolled in the current study. Nine (31%) patients achieved a favorable neurological outcome, and 20 (69%) patients had poor neurological outcomes. results The group of poor neurological outcome had significantly higher proportion of shock on admission and brainstem involvement. Based on multivariate logistic regression analysis, ferritin, aspartate aminotransferase (AST), and ANE severity score (ANE-SS) were the predictors associated with outcomes. The appropriate cutoff value for predicting neurological outcomes in patients with ANE was 1823 ng/mL for ferritin, 78 U/L for AST, and 4.5 for ANE-SS. Besides, comparison analyses showed that higher level of ferritin and ANE-SS were significantly correlated with brainstem involvement (P < 0.05). CONCLUSIONS Ferritin may potentially be a prognostic factor in patients with ANE. Hyperferritinemia is associated with poor neurological outcomes in patients with ANE and ferritin levels more than 1823 ng/mL have about eightfold increased risk of poor neurological outcome.
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Affiliation(s)
- En-Pei Lee
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jainn-Jim Lin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-Pi Chang
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Wei Yen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shun Hsieh
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Oi-Wa Chan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Lin Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ya-Ting Su
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ting Mu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Hsuan Hsia
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Migliorini F, Maffulli N, Shukla T, D'Ambrosi R, Singla M, Vaish A, Vaishya R. The pandemic is gone but its consequences are here to stay: avascular necrosis following corticosteroids administration for severe COVID-19. J Orthop Surg Res 2024; 19:135. [PMID: 38347592 PMCID: PMC10860242 DOI: 10.1186/s13018-024-04556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND In patients with COVID-19 infection and respiratory insufficiency, corticosteroid (CCS) administration is recommended. Among the wide range of complications and interactions, time-limited high-dose CCS administration might promote avascular necrosis (AVN) in a cumulative dose. This systematic review updated the current evidence and characterises the trend of AVN following time-limited high-dose CCS administration in patients who had severe COVID-19, discussing management strategies and outcomes. METHODS This systematic review was conducted according to the 2020 PRISMA statement. In October 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Scopus restricting the search to the years 2019 to 2023. All the clinical studies which investigated the association between time-limited high-dose CCS administration in patients with severe COVID-19 infection and AVN were accessed. RESULTS A total of 245 patients (9 studies) who experienced AVN following COVID-19 were included in the present investigation. 26% (63 of 245 included patients) were women. The mean age of the patients was 42.9 ± 17.7 years. Four studies focused on AVN of the hip and two on the knee, and the other studies included patients with AVN from mixed areas of the body (spine, pelvis, and shoulder). The mean time elapsed from COVID-19 infection to the development of symptomatic AVN was 79.4 ± 59.2 days (range, 14 to 166 days). CONCLUSION It is possible that even time-limited high-dose CCS administration in patients with severe COVID-19 infection increased the incidence of AVN. The mean time elapsed from COVID-19 infection to the development of symptomatic AVN was approximately 80 days. Given the high risk of bias in all the included studies, the quality of recommendations of the present investigation is low, and no reliable conclusion can be inferred.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
| | - Nicola Maffulli
- Department of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy
- Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, ST4 7QB, England
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, E1 4DG, England
| | - Tapish Shukla
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals Institutes of Orthopaedics, New Delhi, 110076, India
| | - Riccardo D'Ambrosi
- Department of Orthopaedics, IRCCS Istituto Ortopedico Galeazzi, 20161, Milan, Italy
| | - Mohit Singla
- Department of Orthopedics, PGIMS, Rohtak, Haryana, 124001, India
| | - Abhishek Vaish
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals Institutes of Orthopaedics, New Delhi, 110076, India
| | - Raju Vaishya
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals Institutes of Orthopaedics, New Delhi, 110076, India
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5
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Lu Y, Wang C, Wang Y, Chen Y, Zhao L, Li Y. Case report: Enhancing prognosis in severe COVID-19 through human herpes virus coinfection treatment strategies. Front Cell Infect Microbiol 2024; 13:1320933. [PMID: 38268789 PMCID: PMC10806028 DOI: 10.3389/fcimb.2023.1320933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
Background In the context of increasing reports of co-infection with coronavirus disease 2019 (COVID-19), particularly with human herpes viruses (HHVs), it is important to consider the appropriate treatment options for HHVs that have been reactivated by COVID-19. Case presentation This study presents two cases of severe COVID-19 with HHV co-infection. The first case involved a critically ill patient with COVID-19 co-infected with herpes simplex virus type 1, confirmed using metagenomic next-generation sequencing, and another patient with severe COVID-19 experiencing Epstein-Barr virus (EBV) reactivation, as evidenced by elevated EBV-DNA levels in the serum. Treatment included high-dose glucocorticoids and sivelestat sodium, with notable improvements observed after initiating ganciclovir anti-herpesvirus therapy. Conclusion This study underscores the significance of recognizing HHV co-infections in severe COVID-19 cases and highlights the potential of combining anti-HHV treatment, increased glucocorticoid dosages, and anti-cytokine storm therapy to enhance prognosis.
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Affiliation(s)
| | | | | | | | | | - Yu Li
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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6
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Mendes-Filho SPDM, de Souza Pinheiro R, Martins FS, Giroldi PJ, e Melo RH, de Oliveira EL, dos Santos AB, Medeiros DCO, Lopes JA, Chaves YO, Zuliani JP, Nogueira PA. Kinetics of IL-6, C-reactive Protein and Fibrinogen Levels in COVID-19 Outpatients Who Evolved to Hypoxemia. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2024; 17:2632010X231222795. [PMID: 38188270 PMCID: PMC10768631 DOI: 10.1177/2632010x231222795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
Introduction Despite the efficacy of the COVID-19, the search for improvements in the management of severe/critical cases continues to be important. The aim is to demonstrate the kinetics of 4 serological markers in patients with COVID-19 who evolved in hypoxemia. Methods From June to December 2020, the Health Secretariat of Rondônia State, Brazil, established a home medical care service team (HMCS) that provided clinical follow-up for health professionals and military personnel with COVID-19. The clinical and laboratory monitoring was individualized at home by a nursing and medical team. In addition to laboratory parameters, C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, and D-dimer levels were periodically taken to monitor the evolution of treatment. Results Of 218 patients telemonitored, 48 patients needed special care by the HMCS team due to shortness of breath. Chest tomography showed multiple ground-glass shadows and lung parenchymal condensations that was compatible with secondary bacterial infection associated with leukocytosis, for which antibiotics were prescribed. The symptoms were accompanied by increases of CRP and IL-6 levels followed by fibrinogen after a few days, for which an anticoagulant therapy was included. Thirty-three patients evolved to improvements in clinical signs and laboratory results. Between the sixth and eighth day of illness, 15 patients presented signs of hypoxemia with low O2 saturation accompanied with an increase in the respiratory rate, with some of them requiring oxygen therapy. As they did not present signs of clinical severity, but their laboratory markers showed an abrupt IL-6 peak that was higher than the increase in CRP and a new alteration in fibrinogen levels, they received a supplemental dose of anticoagulant and a high dose of corticosteroids, which resulted in clinical improvement. Conclusion Our study demonstrates that monitoring of IL-6 and CRP may identify precocious hypoxemia in COVID-19 patients and prevented the progressive deterioration of the lung injury.
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Affiliation(s)
| | - Rebeca de Souza Pinheiro
- Programa de Pós-graduação de Imunologia Básica e Aplicada, Universidade Federal do Amazonas, Manaus/AM, Brazil
| | - Fernanda Simão Martins
- Serviço de Assistência Médica Domiciliar (SAMD), Secretaria Estadual da Saúde (SESAU), Porto Velho/RO, Brazil
| | - Paulo Jose Giroldi
- Laboratório Estadual de Patologia e Análises Clínicas (LEPAC), Porto Velho/RO, Brazil
| | - Raul Honorato e Melo
- Serviço de Assistência Médica Domiciliar (SAMD), Secretaria Estadual da Saúde (SESAU), Porto Velho/RO, Brazil
- Hospital Cemetron, Porto Velho/RO, Brazil
| | | | - Anibal Borin dos Santos
- Serviço de Assistência Médica Domiciliar (SAMD), Secretaria Estadual da Saúde (SESAU), Porto Velho/RO, Brazil
| | | | | | - Yury Oliveira Chaves
- Instituto Leônidas e Maria Deane (ILMD), Fundação Oswaldo Cruz – Amazonas (FIOCRUZ – AMAZONAS), Manaus/AM, Brazil
| | | | - Paulo Afonso Nogueira
- Programa de Pós-graduação de Imunologia Básica e Aplicada, Universidade Federal do Amazonas, Manaus/AM, Brazil
- Instituto Leônidas e Maria Deane (ILMD), Fundação Oswaldo Cruz – Amazonas (FIOCRUZ – AMAZONAS), Manaus/AM, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus/AM, Brazil
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Nagasawa R, Niwa T, Hagiwara E, Oda T, Yamada S, Okuda R, Baba T, Komatsu S, Kaneko T, Ogura T. Safety and Efficacy of Combination Therapy of Remdesivir, Baricitinib, and High-dose Steroids in Patients Hospitalized with Moderate to Severe COVID-19. Intern Med 2023; 62:3125-3130. [PMID: 37438142 PMCID: PMC10686726 DOI: 10.2169/internalmedicine.0761-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 05/02/2023] [Indexed: 07/14/2023] Open
Abstract
Objective Dexamethasone, remdesivir (REM), and baricitinib (BAR) are commonly used to treat coronavirus disease 2019 (COVID-19). High-dose steroids have also been reported to be well tolerated, even when used in combination with multiple drugs. In this retrospective study, we assessed the safety and therapeutic efficacy of a three-drug combination of high-dose steroids, REM, and BAR in hospitalized COVID-19 patients. Methods We retrospectively evaluated the safety and efficacy of three-drug combination therapy. Patients We evaluated 107 patients hospitalized with moderate or severe COVID-19 who underwent 3-drug combination therapy with high-dose steroids (80 mg of methylprednisolone or more, REM, and BAR) in our institution from December 2020 to June 2021. The mean age was 62.1±13.7 years old, and 71.2% were men. The severity of the study patients was as follows: 18 (16.8%) with an 8-category ordinal score of 4, 84 (78.5%) with a score of 5, and 5 (4.7%) with a score of 6. Results The frequency of high-grade adverse events was low, except for hyperglycemia (n=59, 45.8%). The median duration from symptom onset to the start of three-drug combination therapy was eight days. All but one of the patients treated with the combination therapy improved. The median time to improvement by 1 category of the eight-category ordinal score was 6 days, and the 28-day mortality was 0.9%. Conclusion This study showed the safety profile of three-drug combination therapy of high-dose steroids, REM, and BAR in moderate to severe COVID-19 patients. The three-drug combination therapy is well tolerated and has the potential to prevent exacerbation of severity.
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Affiliation(s)
- Ryo Nagasawa
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Japan
| | - Takashi Niwa
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tsuneyuki Oda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Sho Yamada
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Ryo Okuda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Shigeru Komatsu
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
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8
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Yalci A, Doğan E, Kapici MA, Demirkıran BÇ, Filiz M, Artuk C. What we learned from steroid therapy in the COVID-19 pandemic. Niger J Clin Pract 2023; 26:1348-1353. [PMID: 37794549 DOI: 10.4103/njcp.njcp_110_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a pandemic named coronavirus disease 2019 (COVID-19) that has become the greatest worldwide public health threat. Although different treatment recommendations are offered for COVID-19 infection, steroid treatment remains important. Aim We aimed to demonstrate the effect of pulse steroid therapy (PST) on inflammatory markers and patient outcomes in moderate/severe COVID-19 pneumonia. Materials and Methods We retrospectively analyzed the patients 18 years and older hospitalized in our hospital's COVID-19 clinics between April 1, 2020, to June 30, 2020, and July 1, 2021, to November 30, 2021. Patients in the moderate/severe COVID-19 pneumonia category, according to the World Health Organization COVID-19 guidelines, were included in the study. The demographic characteristics of the patients, treatments, inflammatory markers, and patient outcomes (need for intensive care, length of hospital stay, high-flow nasal oxygen (HFNO) requirement, mechanical ventilation (MV), and mortality rates) were recorded and analyzed. Results Patients who received PST had more advanced age (P < 0.01), more comorbidities (P < 0.001), and more HFNO need (P < 001) compared with the patients who did not receive PST. There was no statistically significant difference between clinical outcomes: the need for intensive care, length of hospital stay, need for MV, and mortality rates (P = 0.54, P = 0.3, P = 0.14, and P = 0.09, respectively). When we evaluated the unvaccinated patients, there was a statistically significant difference in the MV need and mortality rates between those who received PST and those who did not (P = 0.017, P = 0.014, respectively). Conclusion It was observed that PST provided similar mortality, ICU, and MV requirements in patients with older age and comorbidities. Lower MV requirements and mortality were observed in the unvaccinated group receiving PST compared with the unvaccinated group not receiving steroids. PST is still promising in COVID-19 infection, and more studies are needed for standard doses and applications.
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Affiliation(s)
- A Yalci
- Department of Infectious Diseases and Clinical Microbiology, University of Health Science, Gülhane Educational and Research Hospital, Ankara, Turkey
| | - E Doğan
- Department of Infectious Diseases and Clinical Microbiology, University of Health Science, Gülhane Educational and Research Hospital, Ankara, Turkey
| | - M A Kapici
- Department of Infectious Diseases and Clinical Microbiology, University of Health Science, Gülhane Educational and Research Hospital, Ankara, Turkey
| | - B Ç Demirkıran
- Department of Infectious Diseases and Clinical Microbiology, University of Health Science, Gülhane Educational and Research Hospital, Ankara, Turkey
| | - M Filiz
- Department of Infectious Diseases and Clinical Microbiology, University of Health Science, Gülhane Educational and Research Hospital, Ankara, Turkey
| | - C Artuk
- Department of Infectious Diseases and Clinical Microbiology, University of Health Science, Gülhane Educational and Research Hospital, Ankara, Turkey
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9
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Sari A, Ekinci O, Saraçoğlu KT, Balık R, Aslan M, Balık Y, Önal C, Aslan M, Cevher S, Parmaksız A, Vatansever Ş, Çicek MC, Ayan ÖS, Şensöz Çelik G, Toprak A, Yılmaz M, Yurt E, Bakan N, Tekin S, Adıyeke E. A Comparison of the Effects of Dexamethasone and Methylprednisolone, Used on Level-3 Intensive Care COVID-19 Patients, on Mortality: A Multi-Center Retrospective Study. J Korean Med Sci 2023; 38:e232. [PMID: 37489719 PMCID: PMC10366414 DOI: 10.3346/jkms.2023.38.e232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/22/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is often a mild disease, usually manifesting with respiratory complaints, and is sometimes mortal due to multiple organ failure. Hyperinflammation is a known COVID-19 component and is associated with organ dysfunction, disease severity and mortality. Controlling hyperinflammatory response is crucial in determining treatment direction. An important agent in providing this control is corticosteroids. This study aimed to determine whether dexamethasone and methylprednisolone, doses, administration time and duration in COVID-19 treatment are associated with improved treatment outcomes. METHODS This retrospective multicenter study was conducted with participation of 6 healthcare centers which collected data by retrospectively examining files of 1,340 patients admitted to intensive care unit due to COVID-19 between March 2020 and September 2021, diagnosed with polymerase chain reaction (+) and/or clinically and radiologically. RESULTS Mortality in the pulse methylprednisolone group was statistically significantly higher than that in the other 3 groups. Mortality was higher in older patients with comorbidities such as hypertension, diabetes mellitus, chronic kidney failure, coronary artery disease, and dementia. Pulse and mini-pulse steroid doses were less effective than standard methylprednisolone and dexamethasone doses, pulse steroid doses being associated with high mortality. Standard-dose methylprednisolone and dexamethasone led to similar effects, but standard dose methylprednisolone was more effective in severe patients who required mechanical ventilation (MV). Infection development was related to steroid treatment duration, not cumulative steroid dose. CONCLUSION Corticosteroids are shown to be beneficial in critical COVID-19, but the role of early corticosteroids in mild COVID-19 patients remains unclear. The anti-inflammatory effects of corticosteroids may have a positive effect by reducing mortality in severe COVID-19 patients. Although dexamethasone was first used for this purpose, methylprednisolone was found to be as effective at standard doses. Methylprednisolone administered at standard doses was associated with greater PaO2/FiO2 ratios than dexamethasone, especially in the severe group requiring MV. High dose pulse steroid doses are closely associated with mortality and standard methylprednisolone dose is recommended.
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Affiliation(s)
- Ahmet Sari
- Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
| | - Osman Ekinci
- Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Kemal Tolga Saraçoğlu
- Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Kartal Dr. Lutfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Recep Balık
- Department of İnfectious Diseases and Clinical Microbiology, Health Sciences University Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Mesut Aslan
- Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Yelda Balık
- Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ceren Önal
- Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Kartal Dr. Lutfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Murat Aslan
- Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Semra Cevher
- Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Aylin Parmaksız
- Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Şeule Vatansever
- Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul, Turkey
| | - Münire Canan Çicek
- Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul, Turkey
| | - Özge Sayın Ayan
- Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul, Turkey
| | - Gaye Şensöz Çelik
- Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul, Turkey
| | - Açelya Toprak
- Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul, Turkey
| | - Mehmet Yılmaz
- Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Derince Training and Research Hospital, Kocaeli, Turkey
| | - Emine Yurt
- Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Derince Training and Research Hospital, Kocaeli, Turkey
| | - Nurten Bakan
- Department of Anesthesiology and Reanimation/Intensive Care, Sancaktepe Şehit Prof Dr Ilhan Varank Training and Research Hospital, İstanbul, Turkey
| | - Selda Tekin
- Department of Anesthesiology and Reanimation/Intensive Care, Sancaktepe Şehit Prof Dr Ilhan Varank Training and Research Hospital, İstanbul, Turkey
| | - Esra Adıyeke
- Department of Anesthesiology and Reanimation/Intensive Care, Sancaktepe Şehit Prof Dr Ilhan Varank Training and Research Hospital, İstanbul, Turkey
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10
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Ayyildiz A, Yildirim OT, Ucan A, Ayyildiz FA. Evaluation of steroid therapy in COVID-19 patients; in the right dose at the right time to the right patients. Niger J Clin Pract 2023; 26:280-286. [PMID: 37056100 DOI: 10.4103/njcp.njcp_1950_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Background Although there is still no universally accepted treatment agent, steroids have been administered chronologically at every dose and at every stage of the COVID-19 pandemic. Aim We aimed to evaluate the clinical efficacy of high-dose steroid therapy and its effect on mortality in COVID-19 patients with severe pneumonia, severe Acute Respiratory Distress Syndrome (ARDS), and septic shock. Patients and Methods : Patients with severe pneumonia, septic shock, and ARDS due to COVID-19 who were followed up in the intensive care unit were retrospectively reviewed. Results The study population was divided into two groups; the methylprednisolone pulse group (MP) (n = 55) and the dexamethasone group (Dex) (n = 39). When the values before and after treatment were compared; there was a statistically significant increase in the neutrophil/lymphocyte ratio after treatment in the MP group (p = 0.006). Although it was not statistically significant in the MP group, There was a numerical increase in D-dimer levels (p = 0.28). Thromboembolic complications developed in 2 patients in the MP group. The mortality outcomes of the groups were statistically similar (p = 0.943). Conclusion We recommend steroids use in the condition that it is indicated in the critically ill group with the poor general condition. Since there is no significant difference between high-dose pulse steroid treatment and standard treatment doses, we think that the risk of complications should not be taken into account and high doses should not be used.
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Affiliation(s)
- A Ayyildiz
- Osmangazi University Faculty of Medicine, Department of Anesthesiology and Reanimation, Eskişehir, Turkey
| | - O T Yildirim
- Eskisehir City Hospital, Department of Cardiology, Eskisehir, Turkey
| | - A Ucan
- Eskişehir City Hospital, Department of Internal Medicine, Eskişehir, Turkey
| | - F A Ayyildiz
- Eskişehir City Hospital, Department of Emergency Medicine, Eskişehir, Turkey
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11
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Clinical outcomes of COVID-19 caused by the Alpha variant compared with one by wild type in Kobe, Japan. A multi-center nested case-control study. J Infect Chemother 2023; 29:289-293. [PMID: 36494058 PMCID: PMC9722619 DOI: 10.1016/j.jiac.2022.11.014] [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: 08/27/2022] [Revised: 11/02/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The emergence of the Alpha variant of novel coronavirus 2019 (SARS-CoV-2) is a concerning issue but their clinical implications have not been investigated fully. METHODS We conducted a nested case-control study to compare severity and mortality caused by the Alpha variant (B.1.1.7) with the one caused by the wild type as a control from December 2020 to March 2021, using whole-genome sequencing. 28-day mortality and other clinically important outcomes were evaluated. RESULTS Infections caused by the Alpha variant were associated with an increase in the use of oxygen (43.4% vs 26.3%. p = 0.017), high flow nasal cannula (21.2% vs 4.0%, p = 0.0007), mechanical ventilation (16.2% vs 6.1%, p = 0.049), ICU care (30.3% vs 14.1%, p = 0.01) and the length of hospital stay (17 vs 10 days, p = 0.031). More patients with the Alpha variant received medications such as dexamethasone. However, the duration of each modality did not differ between the 2 groups. Likewise, there was no difference in 28-day mortality between the 2 groups (12% vs 8%, p = 0.48), even after multiple sensitivity analyses, including propensity score analysis. CONCLUSION The Alpha variant was associated with a severe form of COVID-19, compared with the non-Alpha wild type, but might not be associated with higher mortality.
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12
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Moromizato T, Sakaniwa R, Tokuda Y, Taniguchi K, Shibuya K. Intravenous methylprednisolone pulse therapy and the risk of in-hospital mortality among acute COVID-19 patients: Nationwide clinical cohort study. Crit Care 2023; 27:53. [PMID: 36755340 PMCID: PMC9906603 DOI: 10.1186/s13054-023-04337-5] [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: 10/31/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Steroids are widely used to modulate the inflammatory reactions associated with coronavirus disease 2019 (COVID-19); however, the optimal upper limit dose of steroid use for acute COVID-19 care remains unclear and currently available data may suffer from a time-dependent bias of no effectiveness or reversed causation given the desperate situation of treatment during this pandemic. Accordingly, the aim of this study was to elucidate the impact of intravenous pulse therapy with methylprednisolone (500 mg or greater per day) on the risk of in-hospital mortality among patients with COVID-19 by controlling for time-dependent bias. METHODS We performed a prospective cohort study with 67,348 hospitalised acute COVID-19 patients at 438 hospitals during 2020-2021 in Japan. The impact of intravenous methylprednisolone pulse therapy on the risk of in-hospital mortality was examined based on hazard ratios (HRs) and 95% confidence intervals (95% CIs), with stratification according to the status of invasive mechanical ventilation (iMV). Time-dependent bias was controlled for in a marginal structural model analysis, with reference to patients without methylprednisolone therapy. RESULTS During the study period, 2400 patients died. In-hospital mortality rates of iMV-free patients without or with methylprednisolone pulse therapy were 2.3% and 19.5%, and the corresponding values for iMV-receiving patients were 24.7% and 28.6%, respectively. The marginal structural model analysis showed that intravenous pulse therapy with methylprednisolone was associated with a lower risk of in-hospital mortality among patients receiving-iMV (HR 0.59; 95% CI 0.52-0.68). In contrast, pulse therapy with methylprednisolone increased the risk of in-hospital mortality among iMV-free patients (HR 3.38; 95% CI 3.02-3.79). The benefits of pulse therapy for iMV-receiving patients were greater than in those treated with intermediate/higher doses (40-250 mg intravenously) of methylprednisolone (HR 0.80; 95% CI 0.71-0.89). CONCLUSION The results of our study suggest that intravenous methylprednisolone showed dose-response efficiencies, and pulse therapy may benefit critically ill patients with acute COVID-19, such as those requiring iMV.
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Affiliation(s)
- Takuhiro Moromizato
- Okinawa Nanbu Prefectural Medical Center and Children’s Medical Center, Haebaru, Okinawa Japan ,Tokyo Foundation for Policy Research, Minato-ku, Tokyo Japan
| | - Ryoto Sakaniwa
- grid.136593.b0000 0004 0373 3971Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Osaka Japan
| | - Yasuharu Tokuda
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan. .,Tokyo Foundation for Policy Research, Minato-ku, Tokyo, Japan. .,Muribushi Okinawa Center for Teaching Hospitals, Urasoe, Okinawa, Japan.
| | - Kiyosu Taniguchi
- Tokyo Foundation for Policy Research, Minato-ku, Tokyo Japan ,grid.415573.10000 0004 0621 2362National Hospital Organization Mie National Hospital, Tsu-shi, Mie Japan
| | - Kenji Shibuya
- Tokyo Foundation for Policy Research, Minato-ku, Tokyo Japan
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13
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Mastruzzo C, Commodari E, Grasso U, La Rosa VL, Balsamo D, Circo C, Oliveri R. Early Stage Combination Treatment with Methylprednisolone Pulse and Remdesivir for Severe COVID-19 Pneumonia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1081. [PMID: 36673839 PMCID: PMC9859517 DOI: 10.3390/ijerph20021081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND This study evaluated the clinical outcomes of patients with severe COVID-19 pneumonia treated with remdesivir plus standard corticosteroid treatment (SCT) or with remdesivir plus high-dose corticosteroid pulse therapy (HDCPT). METHODS One hundred and two patients with severe COVID-19 pneumonia and respiratory failure were included. The patients were divided into two cohorts. The first comprised patients who received remdesivir and SCT, consisting of 6 mg dexamethasone daily for up to 10 days or until hospital discharge. The second included patients who received remdesivir and HDCPT, composed of 250 mg iv of methylprednisolone for three days, followed by a slow reduction in the dose of steroids. The severity of hypoxemia was assessed using the SaO2/FiO2 peripheral oxygen saturation index. RESULTS 55 received remdesivir plus HDCPT, and 47 received remdesivir plus SCT. Mortality at 30 days was significantly lower among patients who received remdesivir plus HDCPT (4/55) than among those who did not (15/47). In patients who received remdesivir plus HDCPT, 7.3% required invasive mechanical ventilation and admission to the ICU and 36.4% non-invasive ventilation versus 29.8% and 61.7%, respectively, among those treated with remdesivir plus SCT. Remdesivir plus HDCPT induced a significantly faster improvement in the SaO2/FiO2 index. CONCLUSION Early combination treatment with remdesivir plus HDCPT reduced in-hospital mortality and the need for admission to the ICU. Furthermore, it improved the SaO2/FiO2 index faster in patients with severe COVID-19 pneumonia.
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Affiliation(s)
- Claudio Mastruzzo
- Unit of Respiratory Diseases, Department of Medicine, Garibaldi Hospital, 95124 Catania, Italy
| | - Elena Commodari
- Department of Educational Sciences, University of Catania, 95124 Catania, Italy
| | - Umberto Grasso
- Unit of Internal Medicine, Department of Medicine, Garibaldi Hospital, 95124 Catania, Italy
| | | | - Daniela Balsamo
- Unit of Internal Medicine, Department of Medicine, Garibaldi Hospital, 95124 Catania, Italy
| | - Cristina Circo
- Unit of Respiratory Diseases, Department of Medicine, Garibaldi Hospital, 95124 Catania, Italy
| | - Rosario Oliveri
- Unit of Respiratory Diseases, Department of Medicine, Garibaldi Hospital, 95124 Catania, Italy
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14
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Oda T, Hagiwara E, Yamaya T, Ogura T. Timeline of Oxygen Demand in Patients with COVID-19 Pneumonia. Intern Med 2022; 61:3651-3658. [PMID: 36198590 PMCID: PMC9841100 DOI: 10.2169/internalmedicine.0190-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective In patients with coronavirus disease 2019 (COVID-19), understanding the timeline of oxygen demand and severe respiratory failure, such as intensive care unit (ICU) admission, may clarify the therapeutic window when home-care treatment is possible and help determine the timing of treatment in hospitalized patients to improve the respiratory status. We examined the timeline of respiratory status in hospitalized patients with moderate-to-severe COVID-19 in terms of oxygen demand and ICU admission. Methods We retrospectively assessed all patients with COVID-19 who were admitted to our hospital between February 2020 and February 2021 and required supplemental oxygen. This study included 66 patients who were transferred to the ICU (ICU patients) and 144 patients who were not transferred to the ICU (non-ICU patients). Results In the total cohort, the median duration from symptom onset to the need for supplemental oxygen was 8 [interquartile range (IQR) 6-10] days. This duration was significantly shorter in ICU patients than in non-ICU patients [8 (IQR 6-9) vs. 9 (IQR 6-10) days, p=0.02]. The median duration from symptom onset to ICU admission was 9 (IQR 8-11) days in severely ill patients. The median duration from the initiation of supplemental oxygen to ICU admission was 1.0 (IQR 1-2.75) days. Only 2 of 66 patients (3.0%) were admitted to the ICU six days or later after the initiation of supplemental oxygen. Conclusion Physicians should carefully monitor each patient's condition after eight days from symptom onset. New therapies and their early administration are needed to reduce the frequency of respiratory failure in COVID-19 patients.
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Affiliation(s)
- Tsuneyuki Oda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Takafumi Yamaya
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
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15
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Coronavirus 2019 disease: Are corticosteroids the key treatment? A retrospective case-control study in Brazil. Ann Med Surg (Lond) 2022; 82:104746. [PMID: 36186492 PMCID: PMC9513996 DOI: 10.1016/j.amsu.2022.104746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/17/2022] [Accepted: 09/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is the putative cause of coronavirus disease 2019 (COVID-19), a serious disease that has severely impacted the world. Although vaccines have been developed, it will take time to inoculate the global population. Current guidelines have focused on the treatment of severe cases in hospital settings; however, a void has been created regarding appropriate measures for those in the initial stage of COVID-19 and those experiencing moderate disease severity progressing to desaturation. We assessed clinical outcomes in patients with COVID-19 with pneumonia at initial presentation treated with corticosteroids. Methods Data of 177 consecutive high-risk patients with COVID-19, monitored by telemedicine, were collected and analyzed. Of those, 68 patients were in the initial inflammatory phase of the disease without desaturation and received corticosteroids. The outcomes were evaluated after a follow up of 14 days. Four patients were immediately referred to the hospital because they had explicit desaturation at presentation. Results After 14 days, all patients in the inflammatory phase at presentation who were treated with corticosteroids before desaturation were alive and without complications. However, of the four patients with desaturation, one died at the hospital. Conclusion In this study, the use of corticosteroids during the initial pulmonary phase of COVID-19 before desaturation, in addition to daily monitoring of patients, prevented disease progression, decreased the risk of complications and incidence of hospitalization and death. However, additional studies with larger number of patients are needed to confirm these findings. Use of corticosteroids in COVID-19 patients before desaturation increased survival. Patients who reached desaturation needed hospitalization. Approximately 25% mortality was observed in hospitalized patients. The use of corticosteroids before desaturation prevented hospitalization and death. Corticosteroids can be used to decrease the risk of complications of COVID-19.
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16
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Tan RSJ, Ng KT, Xin CE, Atan R, Yunos NM, Hasan MS. High-Dose versus Low-Dose Corticosteroids in COVID-19 Patients: a Systematic Review and Meta-analysis. J Cardiothorac Vasc Anesth 2022; 36:3576-3586. [PMID: 35715291 PMCID: PMC9101704 DOI: 10.1053/j.jvca.2022.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/11/2022] [Accepted: 05/08/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The clinical efficacy of corticosteroids remains unclear. The primary aim of this systematic review and meta-analysis was to evaluate the use of high-dose versus low- dose corticosteroids on the mortality rate of COVID-19 patients. DESIGN Systematic review and meta-analysis. SETTING Electronic search for randomized controlled trials and observational studies (MEDLINE, EMBASE, CENTRAL). PARTICIPANTS Hospitalized adults ≥ 18 years old who were SARS-CoV-2 PCR positive. INTERVENTIONS High-dose and low-dose corticosteroids. MEASUREMENTS AND MAIN RESULTS A total of twelve studies (n=2759 patients) were included in this review. The pooled analysis demonstrated no significant difference in mortality rate between the high-dose and low-dose corticosteroids groups (n=2632; OR: 1.07 [95%CI 0.67, 1.72], p=0.77, I2=76%, trial sequential analysis=inconclusive). No significant differences were observed in the incidence of intensive care unit (ICU) admission rate (n=1544; OR: 0.77[95%CI 0.43, 1.37], p=0.37, I2= 72%), duration of hospital stay (n=1615; MD: 0.53[95%CI -1.36, 2.41], p=0.58, I2=87%), respiratory support (n=1694; OR: 1.51[95%CI 0.77, 2.96], p=0.23, I2=84%), duration of mechanical ventilation (n=419; MD: -1.44[95%CI -4.27, 1.40], p=0.32, I2=93%), incidence of hyperglycemia (n=516, OR: 0.91[95%CI 0.58, 1.43], p=0.68, I2=0%) and infection rate (n=1485, OR: 0.86[95%CI 0.64, 1.16], p=0.33, I2=29%). CONCLUSION The meta-analysis demonstrated high-dose corticosteroids did not reduce mortality rate. However, high-dose corticosteroids did not pose higher risk of hyperglycemia and infection rate for COVID-19 patients. Due to the inconclusive trial sequential analysis, substantial heterogeneity and low level of evidence, future large-scale randomized clinical trials are warranted to improve the certainty of evidence for the use of high-dose compared to low-dose corticosteroids in COVID-19 patients.
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Affiliation(s)
- Rachel Si Jing Tan
- Department of Anesthesiology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ka Ting Ng
- Department of Anesthesiology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Chua Ee Xin
- Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
| | - Rafidah Atan
- Department of Anesthesiology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Nor'azim Mohd Yunos
- Department of Anesthesiology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - M Shahnaz Hasan
- Department of Anesthesiology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
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17
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Cordeiro Veiga V, Biasi Cavalcanti A. Are intravenous corticosteroid pulses superior to low dose corticosteroids in patients with severe Covid-19? Eur Respir J 2022; 60:13993003.01220-2022. [PMID: 35777764 PMCID: PMC9248174 DOI: 10.1183/13993003.01220-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/18/2022] [Indexed: 11/17/2022]
Abstract
Corticosteroids were the first drugs proven to reduce mortality in Covid-19. In June 2020, the RECOVERY group announced the results of their seminal trial showing dexamethasone 6 mg per day was able to reduce 28-day mortality in hospitalized patients with Covid needing supplemental oxygen or mechanical ventilation [1]. Meta-analysis from randomized controlled trials (RCT) in Covid-19 patients confirmed RECOVERY results [2]. In those RCTs, corticosteroid doses were low (dexamethasone 6 mg per day) or intermediate (dexamethasone up to 20mg per day).
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Affiliation(s)
- Viviane Cordeiro Veiga
- BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil .,BRICNet - Brazilian Research in Intensive Care Network, Brazil
| | - Alexandre Biasi Cavalcanti
- BRICNet - Brazilian Research in Intensive Care Network, Brazil.,Hcor Research Institute, São Paulo, Brazil
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18
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Zhou F, Deng J, Heybati K, Zuo QK, Ali S, Hou W, Wong CY, Ramaraju HB, Chang O, Dhivagaran T, Silver Z. Efficacy and safety of corticosteroid regimens for the treatment of hospitalized COVID-19 patients: a meta-analysis. Future Virol 2022; 17:463-489. [PMID: 35814934 PMCID: PMC9249165 DOI: 10.2217/fvl-2021-0244] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 04/08/2022] [Indexed: 12/15/2022]
Abstract
Aim To evaluate the efficacy and safety of corticosteroids for treating hospitalized COVID-19 patients. Materials & methods Efficacy outcomes included time to negative SARS-CoV-2 tests, length of stay, duration and incidence of intensive unit care stay, incidence of mortality and duration and incidence of mechanical ventilation. Safety outcomes included the incidence of adverse events and severe adverse events, incidence of hyperglycemia and incidence of nosocomial infections. Results Ninety-five randomized controlled trials (RCTs) and observational studies (n = 42,205) were included. Corticosteroids were associated with increased length of stay (based on RCT only), increased time to negative tests, decreased length of mechanical ventilation and increased odds of hyperglycemia. Conclusion Corticosteroids should be considered in patients requiring mechanical ventilation, and glycemic monitoring may be needed when administering corticosteroids.
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Affiliation(s)
- Fangwen Zhou
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Jiawen Deng
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Kiyan Heybati
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Qi Kang Zuo
- Department of Anesthesiology, Rutgers, New Jersey Medical School, 185 S Orange Ave, Newark, NJ 07103, USA
- Faculty of Science, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G5, Canada
| | - Saif Ali
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Wenteng Hou
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Chi Yi Wong
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | | | - Oswin Chang
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Thanansayan Dhivagaran
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
- Integrated Biomedical Engineering & Health Sciences Program (iBioMed), McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Zachary Silver
- Faculty of Science, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
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One-Size-Fits-All Policies Are Unacceptable: A Sustainable Management and Decision-Making Model for Schools in the Post-COVID-19 Era. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105913. [PMID: 35627450 PMCID: PMC9140660 DOI: 10.3390/ijerph19105913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 01/27/2023]
Abstract
This paper proposes a sustainable management and decision-making model for COVID-19 control in schools, which makes improvements to current policies and strategies. It is not a case study of any specific school or country. The term one-size-fits-all has two meanings: being blind to the pandemic, and conducting inflexible and harsh policies. The former strategy leads to more casualties and does potential harm to children. Conversely, under long-lasting strict policies, people feel exhausted. Therefore, some administrators pretend that they are working hard for COVID-19 control, and people pretend to follow pandemic control rules. The proposed model helps to alleviate these problems and improve management efficiency. A customized queue model is introduced to control social gatherings. An indoor–outdoor tracking system is established. Based on tracing data, we can assess people’s infection risk, and allocate medical resources more effectively in case of emergency. We consider both social and technical feasibility. Test results demonstrate the improvements and effectiveness of the model. In conclusion, the model has patched up certain one-size-fits-all strategies to balance pandemic control and normal life.
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20
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Bui TN, Huynh NM, Do-Tran NH, Ngo HA, Tran H, Nguyen NT, Pham TT, Le KD, Nguyen TA. Severe COVID-19 during pregnancy treated with pulse corticosteroid therapy and mid-trimester termination: A case report. Case Rep Womens Health 2022; 34:e00396. [PMID: 35165651 PMCID: PMC8826598 DOI: 10.1016/j.crwh.2022.e00396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background At the early stage of the pandemic, severe COVID-19 was thought to be rare among pregnant women. However, cumulating data showed that gestational state is a risk factor for severe pneumonia, particularly due to the hyperinflammatory state. Recent reports suggested the efficacy of pulse corticosteroids in stopping the cytokine storm in people infected with SARS-CoV-2, but limited data exists regarding its use in pregnant women. Moreover, pregnancy termination is a treatment option in this population, but it has been reported mainly in the third trimester and rarely in the second trimester. Case Presentation A 37-year-old woman infected with SARS-CoV-2 at 23 weeks of gestation presented with fatigue and dyspnea but soon deteriorated to severely acute respiratory failure and cytokine storm requiring mechanical ventilation combined with hemodialysis just one day after hospitalization. Low-dose corticosteroids and antibiotics were initiated, followed by antiviral therapy, anticoagulant and high-dose corticosteroid therapy. On hospital day 3, a decision to terminate her pregnancy was made; termination led to significant improvement in her clinical condition and a gradual decrease in demand for oxygen supplementation as well as the corticosteroid dose. She was discharged two weeks after admission. Conclusions Due to the specific immune response, pregnant women with COVID-19 may differ from others in their clinical presentation, especially the probability of classic acute respiratory distress syndrome (ARDS). This report provides evidence related to the efficacy of pulse corticosteroids on this group and the influence of the mid-trimester termination on recovery. COVID-19 pneumonia can present as acute respiratory distress syndrome in pregnancy. Successful treatment of COVID-19 pneumonia with pulse corticosteroids and mid-trimester medical abortion is reported. The case highlights the need for prompt multidisciplinary team management.
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Affiliation(s)
- Thinh N. Bui
- COVID-19 Intensive Care Unit 2, Thu Duc City Hospital, Ho Chi Minh City, Viet Nam
| | - Nhat M. Huynh
- COVID-19 Intensive Care Unit 2, Thu Duc City Hospital, Ho Chi Minh City, Viet Nam
| | - Nguyen-Huy Do-Tran
- School of Medicine, Vietnam National University Ho Chi Minh City, Viet Nam
| | - Hoang-Anh Ngo
- Woolcock Institute of Medical Research, Hanoi, Viet Nam
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Corresponding author at: Woolcock Institute of Medical Research Vietnam, 298 Kim Ma, Ba Dinh, Hanoi, Viet Nam.
| | - Hung Tran
- COVID-19 Intensive Care Unit 2, Thu Duc City Hospital, Ho Chi Minh City, Viet Nam
| | - Nhan T. Nguyen
- COVID-19 Intensive Care Unit 2, Thu Duc City Hospital, Ho Chi Minh City, Viet Nam
| | - Tung T. Pham
- COVID-19 Intensive Care Unit 2, Thu Duc City Hospital, Ho Chi Minh City, Viet Nam
| | - Kha D. Le
- COVID-19 Intensive Care Unit 2, Thu Duc City Hospital, Ho Chi Minh City, Viet Nam
| | - Thu-Anh Nguyen
- Woolcock Institute of Medical Research, Hanoi, Viet Nam
- Sydney School of Medicine, The Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
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21
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Shetty GM. Double Trouble-COVID-19 and the Widespread Use of Corticosteroids: Are We Staring at an Osteonecrosis Epidemic? Indian J Orthop 2022; 56:226-236. [PMID: 34720174 PMCID: PMC8547122 DOI: 10.1007/s43465-021-00546-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/10/2021] [Indexed: 02/04/2023]
Abstract
Background A combination of immune-mediated vascular damage and routine use of systemic corticosteroid (CS) therapy in COVID-19 may significantly increase the risk and burden of osteonecrosis (ON) after COVID-19. This narrative review explores the pathogenesis, risk factors, and possible preventive and early treatment measures for ON in COVID-19. Methods For this narrative review, an extensive literature search was performed using the PubMed, Medline, and Science Direct databases from January 2000 to August 2021 for relevant articles on etiopathogenesis, epidemiology, clinical manifestations, and treatment of severe acute respiratory syndrome coronavirus (SARS-CoV) infection and steroid-induced ON (SION). Results Pathogenesis of COVID-19, utility of corticosteroids in the treatment of COVID-19, pathogenesis of SION vis-a-vis SARS-CoV infection, associated risk factors, and early diagnosis and treatment of ON following CS therapy of SARS-CoV infection were discussed. Conclusion Preliminary data of COVID-19 and similar trends from the SARS 2003 epidemic indicate that the "angiocentric" pathogenesis of SARS-CoV-2 and treatment with high-dose CS may increase the risk of ON in COVID-19 patients. Risk stratification based on CS intake during COVID-19 treatment can help identify subjects at moderate to high-risk for ON where early preventive and follow-up plans can be initiated.
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Affiliation(s)
- Gautam M. Shetty
- Knee and Orthopaedic Clinic, 407B, Galleria, Hiranandani Gardens, Powai, Mumbai, 400076 India
- AIMD Research, Mumbai, India
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22
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Lavilla Olleros C, Ausín García C, Bendala Estrada AD, Muñoz A, Wikman Jogersen PE, Fernández Cruz A, Giner Galvañ V, Vargas JA, Seguí Ripoll JM, Rubio-Rivas M, Miranda Godoy R, Mérida Rodrigo L, Fonseca Aizpuru E, Arnalich Fernández F, Artero A, Loureiro Amigo J, García García GM, Corral Gudino L, Jiménez Torres J, Casas-Rojo JM, Millán Núñez-Cortés J. Use of glucocorticoids megadoses in SARS-CoV-2 infection in a spanish registry: SEMI-COVID-19. PLoS One 2022; 17:e0261711. [PMID: 35061713 PMCID: PMC8782507 DOI: 10.1371/journal.pone.0261711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022] Open
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.
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Affiliation(s)
| | - Cristina Ausín García
- General Internal Medicine Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ana Muñoz
- General Internal Medicine Department, Infanta Cristina Hospital: Hospital Universitario Infanta 2 Cristina, Parla-Madrid, Spain
| | - Philip Erick Wikman Jogersen
- General Internal Medicine Department, Hospital Universitario San Juan de Alicante, San Juan de Alicante-Alicante, Spain
| | - Ana Fernández Cruz
- General Internal Medicine Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Vicente Giner Galvañ
- General Internal Medicine Department, Hospital Universitario San Juan de Alicante, San Juan de Alicante-Alicante, Spain
| | - Juan Antonio Vargas
- General Internal Medicine Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - José Miguel Seguí Ripoll
- General Internal Medicine Department, Hospital Universitario San Juan de Alicante, San Juan de Alicante-Alicante, Spain
| | - Manuel Rubio-Rivas
- General Internal Medicine Department, H. Univ. de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Rodrigo Miranda Godoy
- General Internal Medicine Department, 12th of October University Hospital: Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Eva Fonseca Aizpuru
- General Internal Medicine Department, Hospital de Cabueñes: Hospital de Cabuenes, Gijón, Spain
| | | | - Arturo Artero
- General Internal Medicine Department, Hospital Universitario Dr Peset: Hospital Universitario Doctor Peset, Valencia, Spain
| | - Jose Loureiro Amigo
- General Internal Medicine Department, Hospital de Sant Joan Despí Moisès Broggi: Hospital de Sant Joan Despi Moises Broggi, Barcelona, Spain
| | - Gema María García García
- General Internal Medicine Department, University Hospital Complex Badajoz: Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | | | - Jose Jiménez Torres
- General Internal Medicine Department, Hospital Reina Sofía: Hospital Reina Sofia, Córdoba, Madrid, Spain
| | - José-Manuel Casas-Rojo
- General Internal Medicine Department, Infanta Cristina Hospital: Hospital Universitario Infanta Cristina, Parla-Madrid, Spain
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23
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Popescu M, Terzea DC, Carsote M, Ghenea AE, Costache A, Popescu IAS, Biciuşcă V, Busuioc CJ, Ghemigian AM. COVID-19 infection: from stress-related cortisol levels to adrenal glands infarction. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2022; 63:39-48. [PMID: 36074666 PMCID: PMC9593124 DOI: 10.47162/rjme.63.1.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cortisol is a key element in acute stress including a severe infection. However, in coronavirus-associated disease, 20% of subjects experience hypocortisolemia due to direct or immune damage of pituitary and adrenal glands. One extreme form of adrenal insufficiency is found in 2∕3 of cases with viral and post-viral adrenal infarction (AI) (with∕without adrenal hemorrhage) that is mostly associated with a severe coronavirus disease 2019 (COVID-19) infection; it requires prompt glucocorticoid intervention. Some reports are incidental findings at computed tomography (CT)∕magnetic resonance imaging (MRI) scans for non-adrenal complications like pulmonary spreading and others are seen on post-mortem analysis. This is a review of PubMed-accessible, English papers focusing on AI in addition to the infection, between March 1, 2020 and November 1, 2021. Exclusion criteria were acute adrenal insufficiency without the histopathological (HP) and∕or imaging report of adrenal enlargement, necrosis, etc., respective adrenal failure due to pituitary causes, or non-COVID-19-related adrenal events. We identified a total of 84 patients (different levels of statistical evidence), as follows: a retrospective study on 51 individuals, two post-mortem studies comprising nine, respectively 12 patients, a case series of five subjects, seven single-case reports. HP aspects include necrosis associated with ischemia, cortical lipid degeneration (+/- focal adrenalitis), and infarcts at the level of adrenal cortex, blood clot into vessels, acute fibrinoid necrosis in arterioles and capsules, as well as subendothelial vacuolization. Collateral potential contributors to adrenal damage are thrombotic events, coagulation anomalies, antiphospholipid syndrome, endothelial dysfunction, severe COVID-19 infection with multiorgan failure, etc. Clinical picture is variable from acute primary adrenal insufficiency to asymptomatic or mild evolution, even a retrospective diagnostic; it may be a part of long COVID-19 syndrome; glucocorticoid therapy for non-adrenal considerations might mask cortisol deficient status due to AI∕hemorrhage. Despite its rarity, the COVID-19-associated AI/hemorrhage represents a challenging new chapter, a condition that is essential to be recognized due to its gravity since prompt intervention with glucocorticoid replacement is lifesaving.
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Affiliation(s)
- Mihaela Popescu
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, C.I. Parhon National Institute of Endocrinology, Bucharest, Romania;
| | - Dana Cristina Terzea
- Department of Pathology and Immunohistochemistry, C.I. Parhon National Institute of Endocrinology, Bucharest, Romania; Department of Pathology and Immunohistochemistry, Monza Onco Team Diagnostic, Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Endocrinology, C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | - Alice Elena Ghenea
- Department of Bacteriology–Virology–Parasitology, University of Medicine and Pharmacy of Craiova, Romania
| | - Andrei Costache
- PhD Student, Doctoral School, University of Medicine and Pharmacy of Craiova, Romania
| | - Iulian Alin Silviu Popescu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Viorel Biciuşcă
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Cristina Jana Busuioc
- Department of Histology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Adina Mariana Ghemigian
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Endocrinology, C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
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24
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Snowden GT, Clement ND, Zhang S, Xue Q, Simpson AHRW. Orthopaedic long COVID - the unknown unknowns : are we facing a pandemic of avascular necrosis following COVID-19? Bone Joint Res 2022; 11:10-11. [PMID: 35014543 PMCID: PMC8801165 DOI: 10.1302/2046-3758.111.bjr-2021-0505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Nick D. Clement
- Royal Infirmary of Edinburgh , Edinburgh, UK
- Department of Orthopaedics and Trauma, University of Edinburgh Queen's Medical Research Institute, Edinburgh, UK
| | - Shenqi Zhang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qingyun Xue
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - A. Hamish R. W. Simpson
- Royal Infirmary of Edinburgh , Edinburgh, UK
- Department of Orthopaedics and Trauma, University of Edinburgh Queen's Medical Research Institute, Edinburgh, UK
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25
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Outcome of Critically Ill COVID-19 Patients According to the Setting of Corticosteroid Initiation-A Retrospective Observational Cohort Study. J Pers Med 2021; 11:jpm11121359. [PMID: 34945831 PMCID: PMC8706060 DOI: 10.3390/jpm11121359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/28/2021] [Accepted: 12/07/2021] [Indexed: 12/15/2022] Open
Abstract
(1) Background: Corticosteroids lower 28-day all-cause mortality in critically ill COVID-19 patients. However, the outcome of COVID-19 patients referred to the intensive care unit (ICU) for respiratory deterioration despite corticosteroids initiated during hospitalization before ICU admission has been poorly investigated. Our objective was to determine survival according to corticosteroid initiation setting. (2) Methods: We conducted a cohort study including all successive critically ill COVID-19 patients treated with corticosteroids and managed in our ICU. We compared survival, whether corticosteroids were initiated before (Cb-group) or after ICU admission (Ca-group), using a propensity score matching. (3) Results: Overall, 228 patients (67 years (56–74); 168M/60F; invasive mechanical ventilation on admission, 17%) were included with 63 patients in the Cb-group and 165 patients in the Ca-group. Survival to hospital discharge was 43% versus 69%, respectively (p = 0.001). In a multivariable analysis, factors associated with death were age (odds ratio, 1.07; 95%-confidence interval, (1.04–1.11); p < 0.0001), the sequential organ failure assessment (SOFA) score on ICU admission (1.30 (1.14–1.50); p = 0.0001) and corticosteroid initiation before ICU admission (2.64 (1.30–5.43); p = 0.007). No significant differences in outcome related to corticosteroid regimen were found. (4) Conclusions: Critically ill COVID-19 patients transferred to the ICU with deterioration despite corticosteroids initiated before admission have a less favorable outcome than patients receiving corticosteroids initiated after ICU admission.
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26
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Pradhan S, Kumar N, Kumar S. Severe COVID-19 along with Cytokine Storm in Pemphigus Vulgaris Managed Successfully with Dexamethasone Pulse Therapy. Indian J Crit Care Med 2021; 25:1320-1321. [PMID: 34866834 PMCID: PMC8608629 DOI: 10.5005/jp-journals-10071-24015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pradhan S, Kumar N, Kumar S. Severe COVID-19 along with Cytokine Storm in Pemphigus Vulgaris Managed Successfully with Dexamethasone Pulse Therapy. Indian J Crit Care Med 2021;25(11):1320–1321.
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Affiliation(s)
- Swetalina Pradhan
- Department of Dermatology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Neeraj Kumar
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Sanjeev Kumar
- Department of CTVS, All India Institute of Medical Sciences, Patna, Bihar, India
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27
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Toroghi N, Abbasian L, Nourian A, Davoudi-Monfared E, Khalili H, Hasannezhad M, Ghiasvand F, Jafari S, Emadi-Kouchak H, Yekaninejad MS. Comparing efficacy and safety of different doses of dexamethasone in the treatment of COVID-19: a three-arm randomized clinical trial. Pharmacol Rep 2021; 74:229-240. [PMID: 34837648 PMCID: PMC8627167 DOI: 10.1007/s43440-021-00341-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/15/2022]
Abstract
Background and objectives Corticosteroids are commonly used in the treatment of hospitalized patients with COVID-19. The goals of the present study were to compare the efficacy and safety of different doses of dexamethasone in the treatment of patients with a diagnosis of moderate to severe COVID-19. Methods Hospitalized patients with a diagnosis of moderate to severe COVID-19 were assigned to intravenous low-dose (8 mg once daily), intermediate-dose (8 mg twice daily) or high-dose (8 mg thrice daily) dexamethasone for up to 10 days or until hospital discharge. Clinical response, 60-day survival and adverse effects were the main outcomes of the study. Results In the competing risk survival analysis, patients in the low-dose group had a higher clinical response than the high-dose group when considering death as a competing risk (HR = 2.03, 95% CI: 1.23–3.33, p = 0.03). Also, the survival was significantly longer in the low-dose group than the high-dose group (HR = 0.36, 95% CI = 0.15–0.83, p = 0.02). Leukocytosis and hyperglycemia were the most common side effects of dexamethasone. Although the incidence was not significantly different between the groups, some adverse effects were numerically higher in the intermediate-dose and high-dose groups than in the low-dose group. Conclusions Higher doses of dexamethasone not only failed to improve efficacy but also resulted in an increase in the number of adverse events and worsen survival in hospitalized patients with moderate to severe COVID-19 compared to the low-dose dexamethasone. (IRCT20100228003449N31). Supplementary Information The online version contains supplementary material available at 10.1007/s43440-021-00341-0.
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Affiliation(s)
- Negar Toroghi
- Department of Clinical Pharmacy, International Campus, School of Pharmacy, Tehran University of Medical Sciences, P.O.Box: 14155/6451, 1417614411 Tehran, Iran
| | - Ladan Abbasian
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahid Nourian
- Department of Clinical Pharmacy, International Campus, School of Pharmacy, Tehran University of Medical Sciences, P.O.Box: 14155/6451, 1417614411 Tehran, Iran
| | - Effat Davoudi-Monfared
- Department of Clinical Pharmacy, International Campus, School of Pharmacy, Tehran University of Medical Sciences, P.O.Box: 14155/6451, 1417614411 Tehran, Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, International Campus, School of Pharmacy, Tehran University of Medical Sciences, P.O.Box: 14155/6451, 1417614411 Tehran, Iran
| | - Malihe Hasannezhad
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Ghiasvand
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Sirous Jafari
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Emadi-Kouchak
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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28
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Voicu S, Goury A, Lacoste-Palasset T, Malissin I, Fanet L, Souissi S, Busto J, Legros V, Sutterlin L, Naim G, M’Rad A, Pepin-Lehaleur A, Deye N, Mourvillier B, Mégarbane B. Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure. J Pers Med 2021; 11:jpm11111238. [PMID: 34834590 PMCID: PMC8622434 DOI: 10.3390/jpm11111238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/12/2021] [Accepted: 11/20/2021] [Indexed: 12/15/2022] Open
Abstract
(1) Background: COVID-19 may lead to refractory hypoxemia requiring venovenous extracorporeal membrane oxygenation (ECMO). Survival rate if ECMO is implemented as rescue therapy after corticosteroid failure is unknown. We aimed to investigate if ECMO implemented after failure of the full-recommended 10-day corticosteroid course can improve outcome. (2) Methods: We conducted a three-center cohort study including consecutive dexamethasone-treated COVID-19 patients requiring ECMO between 03/2020 and 05/2021. We compared survival at hospital discharge between patients implemented after (ECMO-after group) and before the end of the 10-day dexamethasone course (ECMO-before group). (3) Results: Forty patients (28M/12F; age, 57 years (51-62) (median (25th-75th percentiles)) were included, 28 (70%) in the ECMO-before and 12 (30%) in the ECMO-after group. In the ECMO-before group, 9/28 patients (32%) received the 6 mg/day dexamethasone regimen versus 12/12 (100%) in the ECMO-after group (p < 0.0001). The rest of the patients received an alternative dexamethasone regimen consisting of 20 mg/day during 5 days followed by 10 mg/day during 5 days. Patients in the ECMO-before group tended to be younger (57 years (51-59) versus 62 years (57-67), p = 0.053). In the ECMO-after group, no patient (0%) survived while 12 patients (43%) survived in the ECMO-before group (p = 0.007). (4) Conclusions: Survival is poor in COVID-19 patients requiring ECMO implemented after the full-recommended 10-day dexamethasone course. Since these patients may have developed a particularly severe presentation, new therapeutic strategies are urgently required.
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Affiliation(s)
- Sebastian Voicu
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-University, 75010 Paris, France; (S.V.); (T.L.-P.); (I.M.); (L.F.); (S.S.); (L.S.); (G.N.); (A.M.); (A.P.-L.); (N.D.)
| | - Antoine Goury
- Medical Critical Care Department, Robert Debré University Hospital, 51100 Reims, France; (A.G.); (J.B.); (B.M.)
| | - Thomas Lacoste-Palasset
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-University, 75010 Paris, France; (S.V.); (T.L.-P.); (I.M.); (L.F.); (S.S.); (L.S.); (G.N.); (A.M.); (A.P.-L.); (N.D.)
| | - Isabelle Malissin
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-University, 75010 Paris, France; (S.V.); (T.L.-P.); (I.M.); (L.F.); (S.S.); (L.S.); (G.N.); (A.M.); (A.P.-L.); (N.D.)
| | - Lucie Fanet
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-University, 75010 Paris, France; (S.V.); (T.L.-P.); (I.M.); (L.F.); (S.S.); (L.S.); (G.N.); (A.M.); (A.P.-L.); (N.D.)
| | - Samar Souissi
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-University, 75010 Paris, France; (S.V.); (T.L.-P.); (I.M.); (L.F.); (S.S.); (L.S.); (G.N.); (A.M.); (A.P.-L.); (N.D.)
| | - Julia Busto
- Medical Critical Care Department, Robert Debré University Hospital, 51100 Reims, France; (A.G.); (J.B.); (B.M.)
| | - Vincent Legros
- Surgical Critical Care Department, Maison Blanche University Hospital, 51100 Reims, France;
| | - Laetitia Sutterlin
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-University, 75010 Paris, France; (S.V.); (T.L.-P.); (I.M.); (L.F.); (S.S.); (L.S.); (G.N.); (A.M.); (A.P.-L.); (N.D.)
| | - Giulia Naim
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-University, 75010 Paris, France; (S.V.); (T.L.-P.); (I.M.); (L.F.); (S.S.); (L.S.); (G.N.); (A.M.); (A.P.-L.); (N.D.)
| | - Aymen M’Rad
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-University, 75010 Paris, France; (S.V.); (T.L.-P.); (I.M.); (L.F.); (S.S.); (L.S.); (G.N.); (A.M.); (A.P.-L.); (N.D.)
| | - Adrien Pepin-Lehaleur
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-University, 75010 Paris, France; (S.V.); (T.L.-P.); (I.M.); (L.F.); (S.S.); (L.S.); (G.N.); (A.M.); (A.P.-L.); (N.D.)
| | - Nicolas Deye
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-University, 75010 Paris, France; (S.V.); (T.L.-P.); (I.M.); (L.F.); (S.S.); (L.S.); (G.N.); (A.M.); (A.P.-L.); (N.D.)
| | - Bruno Mourvillier
- Medical Critical Care Department, Robert Debré University Hospital, 51100 Reims, France; (A.G.); (J.B.); (B.M.)
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-University, 75010 Paris, France; (S.V.); (T.L.-P.); (I.M.); (L.F.); (S.S.); (L.S.); (G.N.); (A.M.); (A.P.-L.); (N.D.)
- Correspondence: ; Tel.: +33-149958442
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Vecchié A, Batticciotto A, Tangianu F, Bonaventura A, Pennella B, Abenante A, Corso R, Grazioli S, Mumoli N, Para O, Maresca AM, Dalla Gasperina D, Dentali F. High-dose dexamethasone treatment for COVID-19 severe acute respiratory distress syndrome: a retrospective study. Intern Emerg Med 2021; 16:1913-1919. [PMID: 34275096 PMCID: PMC8286167 DOI: 10.1007/s11739-021-02800-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/27/2021] [Indexed: 12/15/2022]
Abstract
Low-dose dexamethasone reduces mortality in patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). We retrospectively analyzed the efficacy of high-dose dexamethasone in patients with COVID-19-related ARDS and evaluated factors affecting the composite outcome (death or invasive mechanical ventilation). From March 4th to April 1st 2020, 98 patients with COVID-19 pneumonia were included. Those who after at least 7 days from symptom onset presented a worsening of the respiratory function or of inflammatory biomarkers were started on intravenous high-dose dexamethasone (20 mg daily for 5 days, followed by 10 mg daily for 5 days). Most patients were males (62%) with a mean age of 69 years. Hypertension and cardiovascular disease (CVD) were prevalent. Following dexamethasone treatment, a significant improvement in PaO2/FiO2 (277.41 [178.5-374.8] mmHg vs. 146.75 [93.62-231.16] mmHg, p < 0.001), PaO2 (88.15 [76.62-112.0] mmHg vs. 65.65 [57.07-81.22] mmHg, p < 0.001), and SpO2 (96 [95-98]% vs. 94 [90-96]%, p < 0.001) was observed. A concomitant decrease in C-reactive protein and ferritin levels was found (132.25 [82.27-186.5] mg/L vs. 7.3 [3.3-24.2] mg/L and 1169 [665-2056] ng/mL vs. 874.0 [569.5-1434] ng/mL, respectively; p < 0.001 for both vs. baseline). CVD was found to increase the risk of the composite outcome (RR 7.64, 95% CI 1.24-47.06, p = 0.028). In hospitalized patients with COVID-19-related ARDS, high-dose dexamethasone rapidly improves the clinical status and decreases inflammatory biomarkers. CVD was found to increase the risk of the composite outcome. These data support the importance of randomized clinical trials with high-dose dexamethasone in COVID-19 patients.
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Affiliation(s)
| | | | - Flavio Tangianu
- Department of Internal Medicine, ASST Sette Laghi, Varese, Italy
| | - Aldo Bonaventura
- Department of Internal Medicine, ASST Sette Laghi, Varese, Italy
| | | | - Alessia Abenante
- Department of Internal Medicine, ASST Sette Laghi, Varese, Italy
| | - Rossana Corso
- Department of Internal Medicine, ASST Sette Laghi, Varese, Italy
| | - Stefano Grazioli
- Department of Internal Medicine, ASST Sette Laghi, Varese, Italy
| | - Nicola Mumoli
- Department of Internal Medicine, Ospedale di Magenta, ASST Ovest Milanese, Legnano, Italy
| | - Ombretta Para
- SOD Medicina Interna I, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | | | | | - Francesco Dentali
- Department of Medicine and Surgery, Insubria University, Varese, Italy.
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Mora-Luján JM, Tuells M, Montero A, Formiga F, Homs NA, Albà-Albalate J, Corbella X, Rubio-Rivas M. High-Dose Methylprednisolone Pulses for 3 Days vs. Low-Dose Dexamethasone for 10 Days in Severe, Non-Critical COVID-19: A Retrospective Propensity Score Matched Analysis. J Clin Med 2021; 10:4465. [PMID: 34640481 PMCID: PMC8509662 DOI: 10.3390/jcm10194465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/14/2021] [Accepted: 09/25/2021] [Indexed: 12/15/2022] Open
Abstract
Corticosteroids are largely recommended in patients with severe COVID-19. However, evidence to support high-dose methylprednisolone (MP) pulses is not as robust as that demonstrated for low-dose dexamethasone (DXM) in the RECOVERY trial. This is a retrospective cohort study on severe, non-critically ill patients with COVID-19, comparing 3-day MP pulses ≥ 100 mg/day vs. DXM 6 mg/day for 10 days. The primary outcome was in-hospital mortality, and the secondary outcomes were need of intensive care unit (ICU) admission or invasive mechanical ventilation (IMV). Propensity-score matching (PSM) analysis was applied. From March 2020 to April 2021, a total of 2,284 patients were admitted to our hospital due to severe, non-critically ill COVID-19, and of these, 189 (8.3%) were treated with MP, and 493 (21.6%) with DXM. The results showed that patients receiving MP showed higher in-hospital mortality (31.2% vs. 17.8%, p < 0.001), need of ICU admission (29.1% vs. 20.5%, p = 0.017), need of IMV (25.9% vs. 13.8, p < 0.001), and median hospital length of stay (14 days vs. 11 days, p < 0.001). Our results suggest that treatment with low-dose DXM for 10 days is superior to 3 days of high-dose MP pulses in preventing in-hospital mortality and need for ICU admission or IMV in severe, non-critically ill patients with COVID-19.
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Affiliation(s)
- José María Mora-Luján
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, 08907 L’Hospitalet de Llobregat, Barcelona, Spain; (M.T.); (A.M.); (F.F.); (N.A.H.); (J.A.-A.); (X.C.); (M.R.-R.)
| | - Manel Tuells
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, 08907 L’Hospitalet de Llobregat, Barcelona, Spain; (M.T.); (A.M.); (F.F.); (N.A.H.); (J.A.-A.); (X.C.); (M.R.-R.)
| | - Abelardo Montero
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, 08907 L’Hospitalet de Llobregat, Barcelona, Spain; (M.T.); (A.M.); (F.F.); (N.A.H.); (J.A.-A.); (X.C.); (M.R.-R.)
| | - Francesc Formiga
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, 08907 L’Hospitalet de Llobregat, Barcelona, Spain; (M.T.); (A.M.); (F.F.); (N.A.H.); (J.A.-A.); (X.C.); (M.R.-R.)
| | - Narcís A. Homs
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, 08907 L’Hospitalet de Llobregat, Barcelona, Spain; (M.T.); (A.M.); (F.F.); (N.A.H.); (J.A.-A.); (X.C.); (M.R.-R.)
| | - Joan Albà-Albalate
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, 08907 L’Hospitalet de Llobregat, Barcelona, Spain; (M.T.); (A.M.); (F.F.); (N.A.H.); (J.A.-A.); (X.C.); (M.R.-R.)
| | - Xavier Corbella
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, 08907 L’Hospitalet de Llobregat, Barcelona, Spain; (M.T.); (A.M.); (F.F.); (N.A.H.); (J.A.-A.); (X.C.); (M.R.-R.)
- School of Medicine, Universitat Internacional de Catalunya, 08195 Barcelona, Spain
| | - Manuel Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, 08907 L’Hospitalet de Llobregat, Barcelona, Spain; (M.T.); (A.M.); (F.F.); (N.A.H.); (J.A.-A.); (X.C.); (M.R.-R.)
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Kumar G, Patel D, Hererra M, Jefferies D, Sakhuja A, Meersman M, Dalton D, Nanchal R, Guddati AK. Do high-dose corticosteroids improve outcomes in hospitalized COVID-19 patients? J Med Virol 2021; 94:372-379. [PMID: 34559436 PMCID: PMC8661573 DOI: 10.1002/jmv.27357] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is characterized by dysregulated hyperimmune response and steroids have been shown to decrease mortality. However, whether higher dosing of steroids results in better outcomes has been debated. This was a retrospective observation of COVID-19 admissions between March 1, 2020, and March 10, 2021. Adult patients (≥18 years) who received more than 10 mg daily methylprednisolone equivalent dosing (MED) within the first 14 days were included. We excluded patients who were discharged or died within 7 days of admission. We compared the standard dose of steroids (<40 mg MED) versus the high dose of steroids (>40 mg MED). Inverse probability weighted regression adjustment (IPWRA) was used to examine whether higher dose steroids resulted in improved outcomes. The outcomes studied were in-hospital mortality, rate of acute kidney injury (AKI) requiring hemodialysis, invasive mechanical ventilation (IMV), hospital-associated infections (HAI), and readmissions. Of the 1379 patients meeting study criteria, 506 received less than 40 mg of MED (median dose 30 mg MED) and 873 received more than or equal to 40 mg of MED (median dose 78 mg MED). Unadjusted in-hospital mortality was higher in patients who received high-dose corticosteroids (40.7% vs. 18.6%, p < 0.001). On IPWRA, the use of high-dose corticosteroids was associated with higher odds of death (odds ratio [OR] 2.14; 95% confidence interval [CI] 1.45-3.14, p < 0.001) but not with the development of HAI, readmissions, or requirement of IMV. High-dose corticosteroids were associated with lower rates of AKI requiring hemodialysis (OR 0.33; 95% CI 0.18-0.63). In COVID-19, corticosteroids more than or equal to 40 mg MED were associated with higher in-hospital mortality.
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Affiliation(s)
- Gagan Kumar
- Department of Pulmonary and Critical Care, Northeast Georgia Health System, Gainesville, Georgia, USA
| | - Dhaval Patel
- Department of Pulmonary and Critical Care, Northeast Georgia Health System, Gainesville, Georgia, USA
| | - Martin Hererra
- Department of Internal Medicine, Northeast Georgia Health System, Gainesville, Georgia, USA
| | - David Jefferies
- Department of Pulmonary and Critical Care, Northeast Georgia Health System, Gainesville, Georgia, USA
| | - Ankit Sakhuja
- Division of Cardiovascular Critical Care, Department of Cardiovascular and Thoracic surgery, West Virginia University, West Virginia, USA
| | | | | | - Rahul Nanchal
- Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Achuta Kumar Guddati
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
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Hou H, Xu J, Li Y, Wang Y, Yang H. The Association of Asthma With COVID-19 Mortality: An Updated Meta-Analysis Based on Adjusted Effect Estimates. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3944-3968.e5. [PMID: 34464749 PMCID: PMC8401144 DOI: 10.1016/j.jaip.2021.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 08/02/2021] [Accepted: 08/11/2021] [Indexed: 12/12/2022]
Abstract
Background The association of asthma with the risk for mortality among coronavirus disease 2019 (COVID-19) patients is not clear. Objective To investigate the association between asthma and the risk for mortality among COVID-19 patients. Methods We performed systematic searches through electronic databases including PubMed, EMBASE, and Web of Science to identify potential articles reporting adjusted effect estimates on the association of asthma with fatal COVID-19. A random-effects model was conducted to estimate pooled effects. Sensitivity analysis, subgroup analysis, meta-regression, Begg's test and Egger's test were also performed. Results Based on 62 studies with 2,457,205 cases reporting adjusted effect estimates, COVID-19 patients with asthma had a significantly reduced risk for mortality compared with those without it (15 cohort studies: 829,670 patients, pooled hazard ratio [HR] = 0.88, 95% confidence interval [CI], 0.82-0.95, I2 = 65.9%, P < .001; 34 cohort studies: 1,008,015 patients, pooled odds ratio [OR] = 0.88, 95% CI, 0.82-0.94, I2 = 39.4%, P = .011; and 11 cross-sectional studies: 1,134,738 patients, pooled OR = 0.87, 95% CI, 0.78-0.97, I2 = 41.1%, P = .075). Subgroup analysis based on types of adjusted factors indicated that COVID-19 patients with asthma had a significantly reduced risk for mortality among studies adjusting for demographic, clinical, and epidemiologic variables (pooled OR = 0.87, 95% CI, 0.83-0.92, I2 = 36.3%, P = .013; pooled HR = 0.90, 95% CI, 0.83-0.97, I2 = 69.2%, P < .001), but not among studies adjusting only for demographic variables (pooled OR = 0.88, 95% CI, 0.70-1.12, I2 = 40.5%, P = .097; pooled HR = 0.82, 95% CI, 0.64-1.06, I2 = 0%, P = .495). Sensitivity analysis proved that our results were stable and robust. Both Begg's test and Egger's test indicated that potential publication bias did not exist. Conclusions Our data based on adjusted effect estimates indicated that asthma was significantly related to a reduced risk for COVID-19 mortality.
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Affiliation(s)
- Hongjie Hou
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jie Xu
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yang Li
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yadong Wang
- Department of Toxicology, Henan Center for Disease Control and Prevention, Zhengzhou, China
| | - Haiyan Yang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China.
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K NK, Patil P, Bhandary SK, Haridas V, N SK, E S, Shetty P. Is butyrate a natural alternative to dexamethasone in the management of CoVID-19? F1000Res 2021; 10:273. [PMID: 34046165 PMCID: PMC8108555 DOI: 10.12688/f1000research.51786.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (CoVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 has affected more than 100 million lives. Severe CoVID-19 infection may lead to acute respiratory distress syndrome and death of the patient, and is associated with hyperinflammation and cytokine storm. The broad spectrum immunosuppressant corticosteroid, dexamethasone, is being used to manage the cytokine storm and hyperinflammation in CoVID-19 patients. However, the extensive use of corticosteroids leads to serious adverse events and disruption of the gut-lung axis. Various micronutrients and probiotic supplementations are known to aid in the reduction of hyperinflammation and restoration of gut microbiota. The attenuation of the deleterious immune response and hyperinflammation could be mediated by short chain fatty acids produced by the gut microbiota. Butyric acid, the most extensively studied short chain fatty acid, is known for its anti-inflammatory properties. Additionally, butyric acid has been shown to ameliorate hyperinflammation and reduce oxidative stress in various pathologies, including respiratory viral infections. In this review, the potential anti-inflammatory effects of butyric acid that aid in cytokine storm depletion, and its usefulness in effective management of critical illness related to CoVID-19 have been discussed.
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Affiliation(s)
- Nithin K. K
- Division of Proteomics and Cancer Biology, Nitte University Center for Science Education and Research, Nitte (Deemed to be University), Mangaluru, Karnataka, 575018, India
| | - Prakash Patil
- Central Research Laboratory, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangaluru, Karnataka, 575018, India
| | - Satheesh Kumar Bhandary
- Department of ENT, Justice K S Hegde Charitable Hospital, Nitte (Deemed to be University), Mangaluru, Karnataka, 575018, India
| | - Vikram Haridas
- Arthritis Superspeciality Center, Hublic, Karnataka, 580020, India
| | - Suchetha Kumari N
- Department of Biochemistry/Central Research Laboratory, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangaluru, Karnataka, 575018, India
| | - Sarathkumar E
- Division of Proteomics and Cancer Biology, Nitte University Center for Science Education and Research, Nitte (Deemed to be University), Mangaluru, Karnataka, 575018, India
| | - Praveenkumar Shetty
- Department of Biochemistry/Central Research Laboratory, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangaluru, Karnataka, 575018, India
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Pradhan S, Sharma S, Kumar A, Singh P. Favourable outcome of severe COVID-19 patients in hyperinflammatory phase with high dose dexamethasone pulse therapy: A series of 10 cases. J Family Med Prim Care 2021; 10:4598-4604. [PMID: 35280644 PMCID: PMC8884322 DOI: 10.4103/jfmpc.jfmpc_963_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/22/2021] [Accepted: 09/08/2021] [Indexed: 01/08/2023] Open
Abstract
The hyperinflammatory phase of COVID-19 occurring because of cytokine storm is the leading cause of mortality and morbidity in the affected patients. Various drugs with no definite cure are being tried to tackle the cytokine storm. Recently high dose corticosteroids are being used to arrest the surge of cytokines. In the current case series, we will be discussing the outcome of high dose dexamethasone pulse therapy in 10 cases of COVID-19 in hyperinflammatory phase who were cured of the disease along with improvement in laboratory parameters without any complications to the therapy.
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