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. 2021 Oct 8;10(19):4610.
doi: 10.3390/jcm10194610.

Evolution of the Use of Corticosteroids for the Treatment of Hospitalised COVID-19 Patients in Spain between March and November 2020: SEMI-COVID National Registry

David Balaz  1   2 , Philip Erick Wikman-Jorgensen  1   2 , Vicente Giner Galvañ  1   2   3 , Manuel Rubio-Rivas  4 , Borja de Miguel Campo  5 , Mariam Noureddine López  6 , Juan Francisco López Caleya  7 , Ricardo Gómez Huelgas  8 , Paula María Pesqueira Fontán  9 , Manuel Méndez Bailón  10 , Mar Fernández-Garcés  11 , Ana Fernández Cruz  12 , Gema María García García  13 , Nicolás Rhyman  14 , Luis Corral-Gudino  15 , Aquiles Lozano Rodríguez-Mancheño  16 , María Navarro De La Chica  17 , Andrea Torregrosa García  18 , José Nicolás Alcalá  19 , Pablo Díaz Jiménez  20 , Leticia Esther Royo Trallero  21 , Pere Comas Casanova  22 , Jesús Millán Núñez-Cortés  23 , José-Manuel Casas-Rojo  24 , On Behalf Of The Semi-Covid-Network
Affiliations

Evolution of the Use of Corticosteroids for the Treatment of Hospitalised COVID-19 Patients in Spain between March and November 2020: SEMI-COVID National Registry

David Balaz et al. J Clin Med. .

Abstract

Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence of new recommendations.

Material and methods: A retrospective, descriptive, and observational study was conducted on adults hospitalised due to COVID-19 in Spain who were included in the SEMI-COVID-19 Registry from March to November 2020.

Results: CTs were used in 6053 (36.21%) of the included patients. The patients were older (mean (SD)) (69.6 (14.6) vs. 66.0 (16.8) years; p < 0.001), with hypertension (57.0% vs. 47.7%; p < 0.001), obesity (26.4% vs. 19.3%; p < 0.0001), and multimorbidity prevalence (20.6% vs. 16.1%; p < 0.001). These patients had higher values (mean (95% CI)) of C-reactive protein (CRP) (86 (32.7-160) vs. 49.3 (16-109) mg/dL; p < 0.001), ferritin (791 (393-1534) vs. 470 (236-996) µg/dL; p < 0.001), D dimer (750 (430-1400) vs. 617 (345-1180) µg/dL; p < 0.001), and lower Sp02/Fi02 (266 (91.1) vs. 301 (101); p < 0.001). Since June 2020, there was an increment in the use of CTs (March vs. September; p < 0.001). Overall, 20% did not receive steroids, and 40% received less than 200 mg accumulated prednisone equivalent dose (APED). Severe patients are treated with higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%.

Conclusions: Patients with greater comorbidity, severity, and inflammatory markers were those treated with CTs. In severe patients, there is a trend towards the use of higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%.

Keywords: COVID-19; Spain; comorbidities; corticosteroids.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient selection flowchart.
Figure 2
Figure 2
(A) Proportion of patients receiving and not receiving corticosteroids during the pandemic in hospitalised patients with COVID-19; (B) proportion of patients receiving and not receiving corticosteroids during the pandemic in patients with severe COVID-19 (modified WHO criteria). Prop: proportion, corsis: systemic corticosteroids.
Figure 3
Figure 3
(A) Evolution of the dose of accumulated prednisone equivalents administered to patients admitted with COVID-19; (B) evolution of the dose of accumulated prednisone equivalent administered dose to patients admitted with severe COVID-19 (modified WHO criteria).
Figure 4
Figure 4
Mortality of patients by corticosteroid dose (accumulated prednisone equivalent dose) and oxygen saturation group.
See this image and copyright information in PMC

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