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

• Published in: Medicina clinica Vol. 156; no. 5; p. 221
• Main Authors: Pascual Pareja, José Francisco, García-Caballero, Rebeca, Soler Rangel, Llanos, Vázquez-Ronda, Miguel Angel, Roa Franco, Silvia, Navarro Jiménez, Gema, Moreno Palanco, Miguel Angel, González-Ruano, Patricia, López-Menchaca, Ramiro, Ruíz-Seco, Pilar, Pagán Muñoz, Bárbara, Gómez Gómez, Alejandro, Pérez-Monte, Beatriz, Fuerte Martínez, Rebeca, Valle López, Jose Luis, Muñoz Blanco, Arturo, Rábago Lorite, Isabel, Martínez Martín, Patricia, Serralta San Martín, Gonzalo, Gómez-Cerezo, Jorge Francisco
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 12-03-2021
• Subjects: Adolescent; Adult; Aged; Anti-Inflammatory Agents - therapeutic use; COVID-19 - complications; COVID-19 - drug therapy; COVID-19 - mortality; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Glucocorticoids - therapeutic use; Hospitalization; Humans; Logistic Models; Male; Middle Aged; Retrospective Studies; Severity of Illness Index; Treatment Outcome; Young Adult; Corticoides; Coronavirus infection disease 2019 (COVID-19); Corticosteroids; Síndrome agudo respiratorio severo por coronavirus 2 (SARS-CoV-2); Enfermedad por coronavirus 2019 (COVID-19); Propensity index; Índice de propensión; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
• ISSN: 1578-8989
• DOI: 10.1016/j.medcli.2020.11.004

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.
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 250mg of prednisone daily and use of equivalent doses greater than or equal to 250mg of prednisone daily. Multivariate analysis was performed using logistic regression, using the propensity index as a covariant.
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 (≥250mg prednisone daily) versus no glucocorticoids treatment (OR: 0.35 [0.11-1.08]) and glucocorticoids treatment (≥250mg prednisone daily) versus patients with glucocorticoids doses <250mg prednisone daily or without glucocorticoids treatment (OR: 0.30 [0.10-0.88]).
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 250mg have a more favorable evolution (less mortality and less admission to ICU).