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. 2021 Mar 12;156(5):221-228.
doi: 10.1016/j.medcle.2020.11.006. Epub 2021 Feb 6.

Effectiveness of glucocorticoids in patients hospitalized for severe SARS-CoV-2 pneumonia

José Francisco Pascual Pareja  1   2 , Rebeca García-Caballero  1 , Llanos Soler Rangel  1   2 , Miguel Angel Vázquez-Ronda  1   2 , Silvia Roa Franco  1 , Gema Navarro Jiménez  1 , Miguel Angel Moreno Palanco  1   2 , Patricia González-Ruano  1   2 , Ramiro López-Menchaca  1 , Pilar Ruíz-Seco  1   2 , Bárbara Pagán Muñoz  1 , Alejandro Gómez Gómez  1 , Beatriz Pérez-Monte  1 , Rebeca Fuerte Martínez  1 , Jose Luis Valle López  1 , Arturo Muñoz Blanco  1 , Isabel Rábago Lorite  1 , Patricia Martínez Martín  1 , Gonzalo Serralta San Martín  1   2 , Jorge Francisco Gómez-Cerezo  1   2 ; HUIS-COVID-19 working group
Affiliations

Effectiveness of glucocorticoids in patients hospitalized for severe SARS-CoV-2 pneumonia

José Francisco Pascual Pareja et al. Med Clin (Engl Ed). .

Abstract
in English, Spanish

Background: Several studies have reported the beneficial effect of glucocorticoids in the treatment of cytokine storm that occurs in patients with severe COVID-19. Various glucocorticoids regimens have been proposed.

Methods: Retrospective observational study that includes patients with severe SARS-CoV-2 pneumonia and compares admission to an Intensive Care Unit (ICU) or death during hospitalization in three groups of patients: no glucocorticoids treatment, use of glucocorticoids doses equivalent to less than 250 mg of prednisone daily and use of equivalent doses greater than or equal to 250 mg of prednisone daily. Multivariate analysis was performed using logistic regression, using the propensity index as a covariant.

Results: Of the 259 patients enrolled in the study, 67 (25.9%) had an unfavorable evolution, dying or requiring ICU admission. Comparative analyzes between different glucocorticoids treatments and the association with ICU admission or death were: glucocorticoids treatment (any dose) versus no glucocorticoids treatment (OR: 0.71 [0.30-1.66]), treatment with glucocorticoids (≥250 mg prednisone daily) versus no glucocorticoids treatment (OR: 0.35 [0.11-1.08]) and glucocorticoids treatment (≥250 mg prednisone daily) versus patients with glucocorticoids doses <250 mg prednisone daily or without glucocorticoids treatment (OR: 0.30 [0.10-0.88]).

Conclusion: The results of this study show that patients with severe SARS-CoV-2 pneumonia treated with glucocorticoids pulses with equivalent doses of prednisone greater than or equal to 250 mg have a more favorable evolution (less mortality and less admission to ICU).

Introducción: Se han comunicado varios trabajos donde se ha demostrado un efecto beneficioso de los glucocorticoides como tratamiento de la tormenta de citocinas que se asocia a los cuadros graves por SARS-CoV-2, plateándose diferentes pautas de glucocorticoides.

Métodos: Estudio observacional retrospectivo que incluye pacientes con neumonía grave por SARS-CoV-2 y compara el ingreso en una unidad de cuidados intensivos (UCI) o fallecimiento durante la hospitalización en 3 grupos de pacientes: sin tratamiento con glucocorticoides, uso de dosis diarias de glucocorticoides equivalentes menores a 250 mg de prednisona y dosis diarias equivalentes mayores o iguales a 250 mg de prednisona. Se realizó un análisis multivariante mediante regresión logística, utilizando el índice de propensión como covariante.

Resultados: De los 259 pacientes incorporados al estudio 67 (25,9%) tuvieron una evolución desfavorable, falleciendo o precisando ingreso en UCI. Los análisis comparativos entre diferentes tratamientos con glucocorticoides, y la asociación con ingreso en UCI o fallecimiento fueron: tratamiento con glucocorticoides (cualquier dosis) versus sin tratamiento con glucocorticoides (OR: 0,71 [0,30–1,66]), tratamiento con glucocorticoides (≥250 mg de prednisona al día) versus sin tratamiento con glucocorticoides (OR: 0,35 [0,11–1,08]) y tratamiento con glucocorticoides (≥250 mg de prednisona al día) versus pacientes con dosis de glucocorticoides < 250 mg de prednisona o sin tratamiento con glucocorticoides (OR: 0,30 [0,10–0,88]).

Conclusión: Los resultados de este estudio muestran que los paciente con neumonía grave por SARS-CoV-2 tratados con pulsos con glucocorticoides con dosis equivalentes de prednisona mayor o igual de 250 mg tienen una evolución más favorable (menos mortalidad e ingreso en UCI).

Keywords: Coronavirus infection disease 2019 (COVID-19); Corticosteroids; Propensity index; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

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Figures

Fig. 1
Fig. 1
Flow chart of patients included and excluded in the study. LMWH: low molecular weight heparin; PCR: gene amplification by polymerase chain reaction; Xr: X-ray; SO2/FiO2: ratio between oxygen saturation and inspiratory oxygen fraction; ICU: intensive care unit.
See this image and copyright information in PMC

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