Abstract
Background: COVID-19 has high mortality in hospitalized patients, and we need effective treatments. Our objective was to assess corticosteroid pulses' influence on 60-days mortality in hospitalized patients with severe COVID-19, intensive care admission, and hospital stay. Methods: We designed a multicenter retrospective cohort study in three teaching hospitals of Castilla y León, Spain (865.096 people). We selected patients with confirmed COVID-19 and lung involvement with a pO2 /FiO2 Findings: From 2933 patients, 257 fulfilled the inclusion and exclusion criteria. One hundred and twenty-four patients were on corticosteroid pulses, and 133 were not. 30·3% (37/122) of patients died in the corticosteroid pulses group and 42·9% (57/133) in the non-exposed cohort. These differences (12·6% CI95% [8·54-16·65]) were statically significant (log-rank 4·72, p=0·03). We performed PSM using the exact method. Mortality differences remained in the PSM group (log-rank 5·31, p=0·021) and were still significant after a Cox regression model (HR for corticosteroid pulses 0·561, p= 0·039). There were no significant differences in intensive care admission rate (p=0·173). The hospital stay was longer in the corticosteroid group (pInterpretation: This study provides evidence about treatment with corticosteroid pulses in severe COVID-19 that might significantly reduce mortality. Strict inclusion and exclusion criteria with that selection process set a reliable frame to compare mortality in both exposed and non-exposed groups. Funding: There was no funding provided.Declaration of Interests: None.Ethics Approval Statement: Approved by the local ethical committee (CEIC) ID. Number: PI 20-1812-COVID
Highlights
In December 2019, a new betacoronavirus called SARS-CoV2 induced severe bilateral pneumonia similar to severe acute respiratory syndrome (SARS), described in 2003
We analyzed patients with COVID-19 admitted between March 12th and May 20th to three tertiary teaching hospitals in Castilla y León, Spain: Hospital Clínico Universitario de Valladolid (HCUV), Hospital Universitario de Salamanca (HUSA), and Hospital Universitario de Burgos (HUBU)
We diagnosed with COVID-19 in 243 patients based on SARS-CoV-2 PCR in the nasopharyngeal or oropharyngeal swabbing and 14 patients based on positive serology with compatible symptoms. 124 patients were on corticosteroid pulses, and 133 were not
Summary
In December 2019, a new betacoronavirus called SARS-CoV2 induced severe bilateral pneumonia similar to severe acute respiratory syndrome (SARS), described in 2003. This coronavirus disease (COVID-19) had lower mortality than. After 32 885 641 cases were confirmed, mortality rates are between 3 and 4% [2], mostly due to acute respiratory distress syndrome (ARDS) and micropulmonary embolism. These symptoms are related to a hyperinflammatory state and a cytokine storm syndrome in some patients [3]. Several authors have postulated that immunosuppressor agents (like corticosteroids, anakinra [4, 5], or tocilizumab [6, 7]) might be useful for these patients
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