Abstract
Objectives: There are limited data regarding the efficacy of methylprednisolone in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) requiring invasive mechanical ventilation. We aimed to determine whether methylprednisolone is associated with increases in the number of ventilator-free days (VFDs) among these patients. Design: Retrospective single-center study. Setting: Intensive care unit. Patients: All patients with ARDS due to confirmed SARS-CoV-2 infection and requiring invasive mechanical ventilation between 1 March and 29 May 2020 were included. Interventions: None. Measurements and Main Results: The primary outcome was ventilator-free days (VFDs) for the first 28 days. Defined as being alive and free from mechanical ventilation. The primary outcome was analyzed with competing-risks regression based on Fine and Gray’s proportional sub hazards model. Death before day 28 was considered to be the competing event. A total of 77 patients met the inclusion criteria. Thirty-two patients (41.6%) received methylprednisolone. The median dose was 1 mg·kg−1 (IQR: 1–1.3 mg·kg−1) and median duration for 5 days (IQR: 5–7 days). Patients who received methylprednisolone had a mean 18.8 VFDs (95% CI, 16.6–20.9) during the first 28 days vs. 14.2 VFDs (95% CI, 12.6–16.7) in patients who did not receive methylprednisolone (difference, 4.61, 95% CI, 1.10–8.12, p = 0.001). In the multivariable competing-risks regression analysis and after adjusting for potential confounders (ventilator settings, prone position, organ failure support, severity of the disease, tocilizumab, and inflammatory markers), methylprednisolone was independently associated with a higher number of VFDs (subhazards ratio: 0.10, 95% CI: 0.02–0.45, p = 0.003). Hospital mortality did not differ between the two groups (31.2% vs. 28.9%, p = 0.82). Hospital length of stay was significantly shorter in the methylprednisolone group (24 days [IQR: 15–41 days] vs. 37 days [IQR: 23–52 days], p = 0.046). The incidence of positive blood cultures was higher in patients who received methylprednisolone (37.5% vs. 17.8%, p = 0.052). However, 81% of patients who received methylprednisolone also received tocilizumab. The number of days with hyperglycemia was similar in the two groups. Conclusions: Methylprednisolone was independently associated with increased VFDs and shortened hospital length of stay. The combination of methylprednisolone and tocilizumab was associated with a higher rate of positive blood cultures. Further trials are needed to evaluate the benefits and safety of methylprednisolone in moderate or severe COVID-19 ARDS.
Highlights
Severe acute respiratory syndrome coronavirus-2 (SAR-CoV-2) responsible for the coronavirus disease 2019 (COVID-19) has hit the world as a global pandemic at an unparalleled scale, causing considerable morbidity and mortality [1,2,3,4]
March 1st and May 29th, 2020, with confirmed SARS-CoV-2 infection and acute respiratory distress syndrome (ARDS), according to the Berlin definition [20], requiring intubation and invasive mechanical ventilation, were included in this study
29th, 2020, 110 adult patients with ARDS caused by COVIDinfectionwere were admitted admitted to to the the intensive care unit (ICU)
Summary
Severe acute respiratory syndrome coronavirus-2 (SAR-CoV-2) responsible for the coronavirus disease 2019 (COVID-19) has hit the world as a global pandemic at an unparalleled scale, causing considerable morbidity and mortality [1,2,3,4]. Up to 12% of hospitalized patients can progress to critical illness with acute respiratory distress syndrome (ARDS). COVID-19 present nonspecific hyperinflammatory responses with a markedly elevated number of proinflammatory cytokines and chemokines [10,11,12]. This excessive and deleterious host immune response is thought to contribute to multi-organ failure in these patients
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