Use of glucocorticoids megadoses in SARS-CoV-2 infection in a spanish registry: SEMI-COVID-19

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. W...

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Detalles Bibliográficos
Autores: Lavilla Olleros, Cristina, Ausín García, Cristina, Bendala Estrada, Alejandro David, Muñoz, Ana, Wikman Jogersen, Philip Erick, Fernández Cruz, Ana, Giner Galvañ, Vicente, Vargas, Juan Antonio, Seguí Ripoll, José Miguel, Rubio Rivas, Manuel, Miranda Godoy, Rodrigo, Mérida Rodrigo, Luis, Fonseca Aizpuru, Eva, Arnalich Fernández, Francisco, Artero, Arturo, Loureiro Amigo, Jose, García García, Gema María, Corral Gudino, Luis, Jiménez Torres, Jose, Casas Rojo, José Manuel, Millán Núñez-Cortés, Jesús, On Behalf of the SEMI-COVID-19 Network
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/187043
Acceso en línea:https://hdl.handle.net/2445/187043
Access Level:acceso abierto
Palabra clave:COVID-19
SARS-CoV-2
Epidemiologia
Corticosteroides
Epidemiology
Adrenocortical hormones
Descripción
Sumario: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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