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. 2020 Dec 14:14:1179548420980699.
doi: 10.1177/1179548420980699. eCollection 2020.

Early Experience With Methylprednisolone on SARS-CoV-2 Infection in the African American Population, a Retrospective Analysis

Subodh J Saggi  1 , Sridesh Nath  1 , Roshni Culas  2 , Seema Chittalae  1 , Aaliya Burza  1 , Maya Srinivasan  1 , Rishard Abdul  1 , Benjamin Silver  1 , Alnardo Lora  1 , Ishmam Ibtida  1 , Tanuj Chokshi  1 , Violeta Capric  1 , Ammar Mohamed  1 , Samrat Worah  1 , Jie OuYang  1 , Patrick Geraghty  1 , Angelika Gruessner  1 , Moro O Salifu  1
Affiliations

Early Experience With Methylprednisolone on SARS-CoV-2 Infection in the African American Population, a Retrospective Analysis

Subodh J Saggi et al. Clin Med Insights Circ Respir Pulm Med. .

Abstract

Background: Coronavirus disease-19 (COVID-19) is associated with acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS) with high mortality rates. In African American (AA) populations, COVID-19 presentations and outcomes are more severe. NIH and Interim WHO guidelines had suggested against the use of corticosteroids unless in clinical trials until the recent publication of the RECOVERY trial. Here, we analyzed the treatment effect of methylprednisolone on patients with AKI and ARDS during the initial 2 months of COVID-19 and detail the learning effect within our institution.

Methods: Between March 1 and April 30, 2020, 75 AA patients met our inclusion criteria for ARDS and AKI, of which 37 had received corticosteroids. Twenty-eight-day mortality, improvement in PaO2/FiO2 ratio, and renal function were analyzed. The impact of methylprednisolone treatment was assessed with multivariable methods.

Results: Survival in the methylprednisolone group reached 51% at 21 days compared to 29% in the non-corticosteroid group (P < .001). Methylprednisolone improved the likelihood of renal function improvement. PaO2/FiO2 ratio in the methylprednisolone group improved by 73% compared to 45% in the non-corticosteroid group (P = .01). Age, gender, BMI, preexisting conditions, and other treatment factors did not show any impact on renal or PaO2/FiO2 ratio improvement. The use of anticoagulants, the month of treatment, and AKI during hospitalization also influenced outcomes.

Conclusion: In AA COVID-19 positive patients with ARDS and AKI, IV methylprednisolone lowered the incidence of mortality and improved the likelihood of renal and lung function recovery. Further investigation with a randomized control trial of corticosteroids is warranted.

Keywords: COVID-19; acute kidney injury; acute respiratory distress syndrome; methylprednisolone.

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Conflict of interest statement

Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Risk factors for improvement of kidney function. Age, Gender, BMI, preexisting conditions, and other treatment factors did not show any significant impact of improvement of kidney function. Abbreviations: AKI, acute kidney injury; HD, Hemodialysis; MAP, mean arterial pressure.
Figure 2.
Figure 2.
Factors for improvement of ARDS. Age, BMI, preexisting conditions, and other treatment factors did not show any significant impact of ARDS improvement. Abbreviations: AKI, acute kidney injury; MAP, mean arterial pressure.
Figure 3.
Figure 3.
Kaplan-Meier survival analysis for patient survival after hospital admission for COVID-19 infection with and without Methylprednisolone treatment.
Figure 4.
Figure 4.
Risk Factor analysis for patient death. Gender, BMI, other treatment factors, and preexisting risk factors did not show any significant impact on patient death. Abbreviations: AKI, acute kidney injury; MAP, mean arterial pressure.
See this image and copyright information in PMC

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