Abstract
Background:Corticosteroids are part of the treatment guidelines for COVID-19 and have been shown to improve mortality. However, the impact corticosteroids have on the development of secondary infection in COVID-19 is unknown. We sought to define the rate of secondary infection in critically ill patients with COVID-19 and determine the effect of corticosteroid use on mortality in critically ill patients with COVID-19.Study Design and Methods:One hundred and thirty-five critically ill patients with COVID-19 admitted to the Intensive Care Unit (ICU) at the University of Maryland Medical Center were included in this single-center retrospective analysis. Demographics, symptoms, culture data, use of COVID-19 directed therapies, and outcomes were abstracted from the medical record. The primary outcomes were secondary infection and mortality. Proportional hazards models were used to determine the time to secondary infection and the time to death.Results:The proportion of patients with secondary infection was 63%. The likelihood of developing secondary infection was not significantly impacted by the administration of corticosteroids (HR 1.45, CI 0.75-2.82, P = 0.28). This remained consistent in sub-analysis looking at bloodstream, respiratory, and urine infections. Secondary infection had no significant impact on the likelihood of 28-day mortality (HR 0.66, CI 0.33-1.35, P = 0.256). Corticosteroid administration significantly reduced the likelihood of 28-day mortality (HR 0.27, CI 0.10-0.72, P = 0.01).Conclusion:Corticosteroids are an important and lifesaving pharmacotherapeutic option in critically ill patients with COVID-19, which have no impact on the likelihood of developing secondary infections.
Highlights
In March 2020, the United States saw a rapid surge in patients presenting with novel coronavirus-19 disease (COVID-19) due to the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) virus
This was a retrospective cohort study of COVID-19 patients admitted to an Intensive Care Unit (ICU) at the University of Maryland Medical Center (UMMC) between March and June of 2020
From March through June 2020, 365 patients were hospitalized at UMMC for COVID-19, of which 147 were admitted to the ICU
Summary
In March 2020, the United States saw a rapid surge in patients presenting with novel coronavirus-19 disease (COVID-19) due to the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) virus. These patients presented with fever, dyspnea, cough, sputum production, and hypoxemia. This remained consistent in sub-analysis looking at bloodstream, respiratory, and urine infections. Conclusion: Corticosteroids are an important and lifesaving pharmacotherapeutic option in critically ill patients with COVID-19, which have no impact on the likelihood of developing secondary infections
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