CMAAO CORONA FACTS and MYTH COVID : Dr K K Aggarwal

Early Steroids : With input from Dr Monica Vasudev

India

healthysoch

New Delhi, September 12, 2020 ;

Corticosteroid use linked to lower risk of condition worsening in non-ICU patients with COVID-19 pneumonia

A study in PLOS ONE has found that early use of moderate-dose systemic corticosteroids in patients admitted to the general ward with coronavirus disease 2019 (COVID-19) pneumonia complicated by acute hypoxic respiratory failure (AHRF) led to a significantly lower rate of the primary composite outcome of ICU transfer, intubation, or in-hospital death.
The single-center retrospective cohort study led by Monil Majmundar, Department of Internal Medicine, Metropolitan Hospital, New York Medical College, New York, NY, screened 265 patients consecutively admitted to non-ICU wards with laboratory-confirmed COVID-19 pneumonia from March 16 to April 30, 2020.
Only the 205 patients who developed AHRF (SpO₂/FiO₂ ≤ 440 or PaO₂/FiO₂ ≤ 300) were included in the final study.
The mean age was approximately 57 years and 153 (74.63%) were male, while 149 (73.04%) patients were of Hispanic ethnicity/race. Of the 205 patients, 60 (29.27%) received systemic corticosteroids, and 145 (70.73%) did not.
Those in the corticosteroid cohort received systemic corticosteroids in the form of methylprednisolone (n = 29, 48.33%), prednisone (n = 10, 16.67%), hydrocortisone (n = 1, 1.67%), and dexamethasone (n = 20, 33.33%).
Corticosteroid was started at a median of 2 days (IQR, 1–5) after admission, on a median or equivalent dose of 80 mg per day (IQR, 60–107) of methylprednisolone (equivalent to 12 (IQR, 9–16) mg of dexamethasone) for a median duration of 5 days (IQR, 4–7).
Out of 202 eligible patients, 13 (22.41%) in the corticosteroid cohort developed the primary composite outcome, compared to 54 (37.5%) patients in the non-corticosteroid group (P = 0.039). The adjusted hazard ratio (HR) for developing the composite primary outcome was 0.15 (95% CI, 0.07–0.33; P <0.001).
Early administration of moderate-dose of any systemic corticosteroid (oral or intravenous) for a shorter duration in COVID-19 viral pneumonia may not be as harmful as initially suspected, and even more beneficial than shown by the RECOVERY trial,” whose early results showed that low-dose (6 mg) dexamethasone cut the risk of death among COVID-19 patients who required oxygen, with or without invasive mechanical ventilation.