Received Corticosteroid Treatment Research Articles

Factors affecting mortality in COVID-19-associated pulmonary aspergillosis: An international ID-IRI study

BackgroundThis study aimed to identify factors that influence the mortality rate of patients with coronavirus disease (COVID-19)-associated pulmonary aspergillosis (CAPA). MethodsIn this cross-sectional study, data from 23 centers across 15 countries, spanning the period of March 2020 to December 2021, were retrospectively collected. The study population comprised patients who developed invasive pulmonary aspergillosis while being treated for COVID-19 in the intensive care unit. Cox regression and decision tree analyses were used to identify factors associated with mortality in patients with CAPA. ResultsA total of 162 patients (males, 65.4 %; median age: 64 [25th–75th: 54.0–73.8] years) were included in the study, of whom 113 died during the 90-day follow-up period. The median duration from CAPA diagnosis to death was 12 (25th–75th: 7–19) days. In the multivariable Cox regression model, an age of ≥65 years (hazard ratio [HR]: 2.05, 95 % confidence interval [CI]: 1.37–3.07), requiring vasopressor therapy at the time of CAPA diagnosis (HR: 1.80, 95 % CI: 1.17–2.76), and receiving renal replacement therapy at the time of CAPA diagnosis (HR: 2.27, 95 % CI: 1.35–3.82) were identified as predictors of mortality. Decision tree analysis revealed that patients with CAPA aged ≥65 years who received corticosteroid treatment for COVID-19 displayed higher mortality rates (estimated rate: 1.6, observed in 46 % of patients). ConclusionThis study concluded that elderly patients with CAPA who receive corticosteroids are at a significantly higher risk of mortality, particularly if they experience multiorgan failure.

The Role of Vitamin D in the Treatment of Carpal Tunnel Syndrome: Clinical and Electroneuromyographic Responses.

Carpal tunnel syndrome (CTS) is the most common cause of peripheral compressive neuropathy and consists of compression of the median nerve in the wrist. Although there are several etiologies, idiopathic is the most prevalent origin, and among the forms of treatment for CTS, conservative is the most indicated. However, despite the high prevalence in and impact of this syndrome on the healthcare system, there are still controversies regarding the best therapeutic approach for patients. Therefore, noting that some studies point to vitamin D deficiency as an independent risk factor, which increases the symptoms of the syndrome, this study evaluated the role of vitamin D supplementation and its influence on pain control, physical examination and response electroneuromyography to conservative treatment of carpal tunnel syndrome. For this, the sample consisted of 14 patients diagnosed with CTS and hypovitaminosis D, who were allocated into two groups. The control group received corticosteroid treatment, while the experimental group received corticosteroid treatment associated with vitamin D. Thus, from this study, it can be concluded that patients who received vitamin D, when compared to those who did not receive it, showed improvement in the degree of pain intensity, a reduction in symptom severity and an improvement in some electroneuromyographic parameters.

Purpureocillium lilacinum-related endophthalmitis: case report

PurposeTo report a case of Purpureocillium lilacinum endophthalmitis.MethodsThe case of a fungal endophthalmitis caused by Purpureocillium lilacinum documented in an immunocompetent patient with no apparent trigger.ResultsA 64-year-old male with a two-month history of panuveitis in his left eye was referred to our hospital. Initially misdiagnosed as sympathetic ophthalmia due to a previous surgery on his right eye 4 months before the onset of the left ocular picture, the patient received corticosteroid treatment, leading to a rapid deterioration of the left eye condition. An urgent exploratory vitrectomy was performed to identify the underlying cause, revealing endophthalmitis. Microbiological investigation yielded Purpureocillium lilacinum as the causative agent. Despite intensive treatment, including intravitreal antibiotics and antifungals, along with another surgical intervention, clinical evolution remained unfavourable, ultimately leading to the evisceration of the affected eye.ConclusionsPurpureocillium lilacinum poses a rare yet sever threat as a causative agent of fungal endophthalmitis. Managing such cases is challenging due to the delayed identification, fungus’s resistance to common antifungals, and its association with prior corticosteroid misuse in most patients. This case underscores the crucial importance of heightened clinical suspicion, early diagnosis, and the exploration of alternative treatment strategies in addressing Purpureocillium lilacinum endophthalmitis. The challenges posed by this rare fungal pathogen emphasize the need for a multidisciplinary approach and continued research to improve outcomes in these complex cases.

Perspectives in Smoking Related Interstitial Lung Diseases

Abstract Interstitial lung disease is a generic term encompassing a wide range of unrelated conditions that have in common a tendency to cause shortness of breath and/or cough associated with bilateral abnormal opacity of various types on conventional chest X-rays or high-resolution computed tomography scans, symptoms including dyspnea, wheezing, cough, and/or sputum production. This study aimed to show that cigarette smoke is a powerful inducer of inflammation and the cause-effect relationship between cigarette smoking and interstitial diseases – respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) and desquamative interstitial pneumonia (DIP). We bring to your attention the cases of two patients, heavy smokers with HRCT images suggestive for RB-ILD and DIP. The patients present to the on-call room with dry cough, exertional dyspnea and receive corticosteroid treatment with the recommendation to cease smoking. An approach would be to target high-risk populations, such as older adults with a history of smoking for early diagnosis of parenchymal lung diseases (e.g. ILD and chronic obstructive pulmonary disease) or lung cancer.

Sequelae Treatment Needs Following Peripheral Facial Palsy: Retrospective Analysis of 525 Patients.

This study uses retrospective longitudinal data from a large unselected cohort of patients with peripheral facial paralysis to determine the prevalence and patient characteristic predictors of sequelae receiving intervention. Retrospective case review. Karolinska University Hospital in Stockholm Sweden serves as the only tertiary facial palsy center in the region. Here, patients are diagnosed, are followed up, and undergo all major interventions. All adult patients presenting with peripheral facial palsy due to idiopathic, zoster, or Borrelia origin at Karolinska, January 1, 2010 to December 31, 2011 with follow-up until December 2022. Patient charts were studied to identify patient characteristics, etiology, initial treatment, severity of palsy, and treatments targeting sequelae. Types of initial and late treatments were noted. Sunnybrook and/or House-Brackmann scales were used for palsy grading. Five hundred twenty-five patients were included. Thirty-three patients (6.3%) received botulinum toxin injections and/or surgical treatment. In this subgroup, 67% received corticosteroids compared to 85% of all patients ( p = 0.005), cardiovascular disease prevalence was higher (23 and 42%, respectively, p = 0.009). For 81 patients (15%), follow-up was discontinued although the last measurement was Sunnybrook less than 70 or House-Brackmann 3 to 6. Of patients with peripheral facial palsy, 6.3% underwent injections and/or surgical treatment within 12 years. However, due to a rather large proportion not presenting for follow-up, this might be an underestimation. Patients receiving late injections and/or surgical treatment had more comorbidities and received corticosteroid treatment to a significantly lower extent in the acute phase of disease.

Comprehensive Nomograms Using Routine Biomarkers Beyond Eosinophil Levels: Enhancing Predictability of Corticosteroid Treatment Outcomes in AECOPD.

Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) exhibit heterogeneous responses to corticosteroid treatment. We aimed to determine whether combining eosinophil levels with other routine clinical indicators can enhance the predictability of corticosteroid treatment outcomes and to come up with a scoring system. Consecutive patients admitted with AECOPD receiving corticosteroid treatment between July 2013 and March 2022 at Beijing Chao-Yang Hospital were retrospectively analyzed. Data on patients' demographics, smoking status, hospitalization for AECOPD in the previous year, comorbidities, blood laboratory tests, in-hospital treatment and clinical outcomes were collected. Least absolute shrinkage and selection operator (LASSO) regression and backward logistic regression were used for predictor selection, and predictive nomograms were developed. The discrimination and calibration of the nomograms were assessed using the area under the receiver operating curve (AUC) and calibration plots. Internal validation was performed using the 500-bootstrap method, and clinical utility was evaluated using decision curve analysis (DCA). Among the 3254 patients included, 804 (24.7%) had treatment failure. A nomogram of eosinophils, platelets, C-reactive protein (CRP), low density lipoprotein cholesterol, prognostic nutritional index (PNI), hospitalization for AECOPD in the previous year, ischemic heart diseases and chronic hepatic disease was developed to predict treatment failure for patients with a smoking history. For patients without a smoking history, a nomogram of CRP, PNI, ischemic heart diseases and chronic hepatic disease was developed. Although the AUCs of these two nomograms were only 0.644 and 0.647 respectively, they were significantly superior to predictions based solely on blood eosinophil levels. We developed easy-to-use comprehensive nomograms utilizing readily available clinical biomarkers related to inflammation, nutrition and immunity, offering modestly enhanced predictive value for treatment outcomes in corticosteroid-treated patients with AECOPD. Further investigations into novel biomarkers and additional patient data are imperative to optimize the predictive performance.

Association between different corticosteroid regimens used in severe SARS-CoV-2 infection and short-term mortality: retrospective cohort study

IntroductionDuring the SARS-CoV-2 pandemic, several corticosteroid regimens have been used in the treatment of the disease, with disparate results according to drug and regimen used. For this reason, we wanted to analyze differences in early mortality derived from the use of different regimens of dexamethasone and methylprednisolone in SARS-CoV-2 infection in critically ill patients requiring admission to an ICU. MethodObservational, analytical and retrospective study, in an intensive care unit of a third-level university hospital, (March 2020 and June 2021). Adult patients (>18 years old) who were admitted consecutively for proven SARS-CoV-2 infection were included. The association with mortality in ICU at 28 days, different corticosteroid regimens used, was analyzed using a Cox proportional risk regression model. ResultsData from a cohort of 539 patients were studied. Patient age (RR: 1.06; 95% CI: 1.02–1.10; P=<0.01) showed a significant association with 28-day mortality in the ICU. In the comparison of the different corticosteroid regimens analyzed, taking as a reference those patients who did not receive corticosteroid treatment, the dose of dexamethasone of 6mg/day showed a clear trend towards statistical significance as a protector of mortality at 28 days in the ICU (RR: 0.40, 95% CI: 0.15–1.02, p=0.05). The dose of dexamethasone of 6mg/day and low doses of methylprednisolone show a similar association with survival at 28 days (OR: 1.19; 95% CI: 0.63–2.26). ConclusionsThe use of corticosteroids has been associated with better mortality outcomes in severe cases of SARS-CoV-2 infection. However, the therapeutic benefits of corticosteroids are not limited to dexamethasone alone.

IgG4-Related Infiltrative Kidney Disease without Extrarenal Organ Involvement: A Case Report

Background: IgG4-related disease (RD) is a systemic condition that can affect nearly all organs. Renal involvement encompasses interstitial nephritis, membranous nephropathy, and renal infiltrative lesions. Symptomatic IgG4-related kidney disease (RKD) without extrarenal organ manifestations is an exceptionally rare occurrence. Case Report: The authors present a case of 48-year-old male with isolated renal IgG4-RD presented with abdominal pain. Laboratory investigations revealed acute kidney injury, proteinuria, and hypoalbuminemia. Whole abdominal computed tomography (CT) scan disclosed infiltrative lesions in both kidneys and ureters, accompanied by hydronephrosis. Kidney biopsy demonstrated lymphocytic and plasma cell infiltration, with 82 plasma cells per high power field (HPF), storiform fibrosis, and the absence of obliterative phlebitis. After receiving corticosteroid treatment, the patient’s renal function improved, and the infiltrative lesions went into remission. Conclusion: Isolated renal IgG4-RD is a rare and challenging diagnosis. The disease can manifest as acute interstitial nephritis, glomerular disease, retroperitoneal fibrosis, or, rarely, as mass or infiltrative lesions. Corticosteroid therapy is likely to yield favorable responses, hence, prompt diagnosis is crucial. Delayed diagnosis may result in organ fibrosis and dysfunction. Keywords: IgG4-related disease; IgG4-related kidney disease; Infiltrative renal disease

Screening for Asymptomatic Osteonecrosis of the Hip in Systemic Lupus Erythematous: A Systematic Review and Meta-Analysis of MRI-Based Prevalence.

Objective. This paper aims to estimate asymptomatic hip osteonecrosis prevalence in SLE patients using MRI examination and to determine the prevalence among higher risk subpopulations. Materials and Methods. PubMed, Embase, Cochrane, and SCOPUS were searched from inception to May 9th, 2023. Studies on patients who were clinically diagnosed with systemic lupus erythematosus without reported symptoms attributable to hip osteonecrosis were included. Two independent reviewers extracted data and assessed the risk of bias. Data collected from each study include the study year, the number of hips screened, the number of hips with osteonecrosis, demographics, laboratory data, medications, follow-up time, radiological protocols, and MRI-based osteonecrosis detection and grading criteria. Results. Eleven eligible studies including 503 participants (15-35 years old; 74-100% female) with SLE were identified. Significant risk of bias was determined in one study. The overall prevalence of osteonecrosis of the hip was found to be 14% (184/1006 hip joints, 95% confidence interval: 7-22%, number needed to scan: 7.1). SLE patients who received corticosteroid treatment had a higher prevalence of asymptomatic hip osteonecrosis (18%) compared to non-corticosteroid users (0%, p-value < 0.01). Additionally, meta-regression results revealed that daily corticosteroid dose was associated with increased prevalence of asymptomatic osteonecrosis (0.5%/milligram, p-value < 0.01). Conclusions. The high prevalence of asymptomatic hip osteonecrosis in SLE patients raises concerns about the timeliness of interventions. The limitations of this study include a relatively low number of identified studies; and one study lacked full-text availability.

P852 Metataxonomic and metabolomic profiling to predict response to anti-TNF therapy in Crohn’s Disease

Abstract Background The composition of the gut microbiota is associated with response to treatments in inflammatory bowel disease1. We sought to identify gut microbial and metabolomic biomarkers associated with response to anti-TNF therapy in Crohn’s disease. Methods Faecal and serum samples collected at baseline and week 14 of anti-TNF treatment in the "Predictors of anti-TNF treatment failure" (PANTS) study were used2. Response to treatment (defined clinically and biochemically) was determined at week 142. Faecal samples were processed by GA-map®, with targeted 16S rRNA PCR sequencing. Serum samples were analysed with targeted liquid chromatography tandem mass spectrometry for bile acids and tryptophan metabolites. Multivariate and univariate analyses, as well as Spearman’s rank test, were performed. Results Two-hundred and twenty-four patients with Crohn’s disease commencing anti-TNF therapy were included (54.1% anti-TNF responders, 48.6% female, median age 37.2 (26.5-50.0) years, 56.9% receiving immunomodulator-based treatment). A significantly higher proportion of non-responders received corticosteroid treatment compared to responders at baseline (p=0.0009). Sixty-nine bacterial taxa were identified. Significantly lower abundances of Clostridium difficile and Mycoplasma were identified in responders relative to non-responders at baseline (q-value=0.046 and q-value=0.034, respectively). No significant differences in the abundances of Faecalibacterium prausnitzii, Shigella or Escherichia Coli were found (all q-values &amp;gt; 0.05). Eighteen serum bile acids and thirteen tryptophan metabolites were identified. Significantly higher serum abundances of cholic acid, tryptophan and 3OH-kynurenine were identified in responders at baseline (q-values=0.049, 0.033, and 0.033, respectively). Exploration of microbial–metabolite associations revealed negative correlations between secondary bile acids and several bile salt hydrolase producing bacteria, such as Bifidobacterium (r ≤ -0.50). Positive correlations were also identified between xanthurenic acid and Bifidobacterium and Roseburia intestinalis (r ≥ 0.50). Increased abundances of short-chain fatty acid producing bacteria, such as Bifidobacterium and Bacteroides vulgatus, were noted in responders at week 14. Conclusion We have identified baseline differences in the faecal microbiota and serum metabolome of anti-TNF responders and non-responders. These findings require validation in larger cohorts to determine their robustness for potential use in treatment personalisation.

Non-IgG4-Related Fibrosing Mediastinitis Diagnosed on Core Needle Biopsy and Treated with Steroids: A Case Study and Review of the Differential Diagnoses.

This study aimed to investigate the histological characteristics and treatment efficacy of non-immunoglobulin G4-related fibrosing mediastinitis and discuss differential diagnoses for this rare entity. We present a case study of non-immunoglobulin G4-related fibrosing mediastinitis diagnosed on core biopsy and treated with steroids. A total of four 18-gauge core needle biopsy specimens were obtained for surgical pathology. Analysis of the patient's medical history, radiological characteristics of fibrosing mediastinitis, histological features, immunohistochemistry results, the differential diagnosis and treatment efficacy of different types of fibrosing mediastinitis was performed. This report describes a unique presentation of fibrosing mediastinitis (syncope and weight loss) that was concerning for malignancy. Histological, laboratory and radiographical studies confirmed the diagnosis of non-immunoglobulin G4-related fibrosing mediastinitis. The patient received corticosteroid treatment which showed marked improvement after 1 month of treatment. Fibrosing mediastinitis is an extremely uncommon entity with unknown pathogenesis, and it is more important to rule out malignancy and infection than to delineate between fibrosing mediastinitis and IgG4-related disease. In doing this, we may reasonably initiate a trial of corticosteroids which may prove beneficial, as in this patient. More studies on the pathogenesis of fibrosing mediastinitis are necessary to guide better directed treatments.

Asociación entre diferentes pautas de corticoides empleadas en la infección grave por SARS-CoV-2 y la mortalidad a corto plazo: estudio de cohortes retrospectivo

IntroductionDuring the SARS-CoV-2 pandemic, several corticosteroid regimens have been used in the treatment of the disease, with disparate results according to drug and regimen used. For this reason, we wanted to analyze differences in early mortality derived from the use of different regimens of dexamethasone and methylprednisolone in SARS-CoV-2 infection in critically ill patients requiring admission to an ICU. MethodObservational, analytical and retrospective study, in an intensive care unit of a third-level university hospital (March 2020 and June 2021). Adult patients (>18 years old) who were admitted consecutively for proven SARS-CoV-2 infection were included. The association with mortality in ICU at 28 days, different corticosteroid regimens used, was analyzed using a Cox proportional risk regression model. ResultsData from a cohort of 539 patients were studied. Patient age (RR: 1.06; 95% CI: 1.02-1.10; P≤0.01) showed a significant association with 28-day mortality in the ICU. In the comparison of the different corticosteroid regimens analyzed, taking as a reference those patients who did not receive corticosteroid treatment, the dose of dexamethasone of 6mg/day showed a clear trend towards statistical significance as a protector of mortality at 28 days in the ICU (RR: 0.40; 95% CI: 0.15-1.02; p=.05). The dose of dexamethasone of 6 mg/day and low doses of methylprednisolone show a similar association with survival at 28 days (OR: 1.19; 95% CI: 0.63-2.26). ConclusionsThe use of corticosteroids has been associated with better mortality outcomes in severe cases of SARS-CoV-2 infection. However, the therapeutic benefits of corticosteroids are not limited to dexamethasone alone.

Relationship Between Corticosteroid Administration and Survival Period in Terminal Cancer Patients.

Objective: Corticosteroids are commonly used for symptom relief in patients with terminal cancer, but their use may have an impact on patient survival. We compared the survival of patients with terminal cancer who did and did not receive corticosteroid treatment for symptom relief, stratified by their predicted prognosis. Methods: We retrospectively reviewed consecutive patients with cancer who received corticosteroid treatment for symptom relief in a single palliative care unit. We stratified the patients according to their predicted prognosis using the palliative prognostic (PaP) score either before starting the corticosteroid treatment or at admission for control patients who did not receive a corticosteroid treatment. The 2 groups were compared for survival based on the PaP Scores. Results: We analyzed 204 patients treated with a corticosteroid during the study period and 139 control patients who did not receive corticosteroids during their treatment. No difference was observed in the survival between the treatment and control groups. Conclusion: Corticosteroid treatment for symptom relief in patients with terminal cancer did not affect survival time.

Alcoholic Foamy Degeneration, an Entity Resembling Alcohol-Associated Hepatitis: Diagnosis, Prognosis, and Molecular Profiling

Alcoholic foamy degeneration (AFD) is a condition with similar clinical presentation to alcohol-associated hepatitis (AH), but with a specific histologic pattern. Information regarding the prevalence and prognosis of AFD is scarce and there are no tools for a noninvasive diagnosis. A cohort of patients admitted to the Hospital Clinic of Barcelona for clinical suspicion of AH who underwent liver biopsy was included. Patients were classified as AFD, AH, or other findings, according to histology. Clinical features, histology, and genetic expression of liver biopsy specimens were analyzed. The accuracy of National Institute on Alcohol Abuse and Alcoholism criteria and laboratory parameters for differential diagnosis were investigated. Of 230 patients with a suspicion of AH, 18 (8%) met histologic criteria for AFD, 184 (80%) had definite AH, and 28 (12%) had other findings. In patients with AFD, massive steatosis was more frequent and the fibrosis stage was lower. AFD was characterized by down-regulation of liver fibrosis and inflammation genes and up-regulation of lipid metabolism and mitochondrial function genes. Patients with AFD had markedly better long-term survival (100% vs 57% in AFD vs AH; P= .002) despite not receiving corticosteroid treatment, even in a model for end-stage liver disease-matched sensitivity analysis. Serum triglyceride levels had an area under the receiver operating characteristic of 0.886 (95% CI, 0.807-0.964) for the diagnosis of AFD, whereas the National Institute on Alcohol Abuse and Alcoholism criteria performed poorly. A 1-step algorithm using triglyceride levels of 225 mg/dL (sensitivity, 0.77; specificity, 0.90; and Youden index, 0.67) is proposed for differential diagnosis. AFD in the setting of suspicion of AH is not uncommon. A differential diagnosis is important because prognosis and treatment differ largely. Triglyceride levels successfully identify most patients with AFD and may be helpful in decision making.

Comparison of Changes in Inflammation Markers NLR, CRP, and LCR after Corticosteroid Therapy in Severe and Critical COVID-19 Patients

Corticosteroid, an immunomodulator agent for treating hyperinflammation, is widely used in severe and critical COVID-19 patients. This study is a retrospective observational cohort clinical study comparing changes in NLR, CRP, and LCR values with and without corticosteroid therapy in critically ill COVID-19 patients. Those samples were chosen due to widespread access and economically sound to be examined repetitively. Samples were collected by total sampling of medical records of patients admitted to the COVID-19 intensive care unit at RSUD Dr Soetomo between March 2020 to July 2021. Inclusion criteria are complete medical records of patients &gt; 18 years with a confirmed COVID-19 diagnosis with severe and/or acute symptoms according to the WHO criteria and receiving corticosteroids (dexamethasone 6 mg/24 h or equivalent dose) for a minimum of 3 days. Patients not receiving corticosteroid treatment were included in the control group. NLR, CRP, and LCR were evaluated on day-0, day-3, day-6, and day-10 after initiation of corticosteroid therapy; in the control group, their hospital admission was designated as day-0. Comorbidities, complications, and other therapies that may affect NLR, CRP, and LCR values are noted. A total of 460 patients were included in the inclusion criteria. The control group had no significant median NLR, CRP, and LCR changes during observation (p-value &gt; 0.05). In the therapy group, there was a significant increase in NLR and LCR and a decrease in CRP (p-value &lt; 0.0001). When compared between control and therapy groups, the median changes in NLR and CRP differed significantly (p-value &lt; 0.05), while significant differences in LCR occurred on days 6 and 10. Corticosteroid increases NLR and LCR and decreases CRP with significant differences between groups. HIGHLIGHTS Corticosteroid treatment significantly increases NLR and LCR levels, while CRP levels decrease significantly in severe and critical COVID-19 patients NLR measurements are unsuitable as indicators of post-therapy inflammatory status during the ongoing immunopathological process of COVID-19 or due to a period of neutrophilia caused by the steroid itself LCR measurement can detect alterations in inflammatory status up to the tenth day following corticosteroid treatment in patients with severe COVID-19 CRP measurements remain a reliable indicators of inflammatory status changes for up to 10 days following corticosteroid therapy in severe and critical COVID-19 patients GRAPHICAL ABSTRACT

390. Corticosteroid Treatment in Severe Patients with SARS-CoV-2 and Chronic HBV Co-infection: A Retrospective Multicenter Study

Abstract Background The impact of corticosteroids on patients with severe coronavirus disease 2019 (COVID-19)/chronic hepatitis B virus (HBV) co-infection is currently unknown. We aimed to investigate the association of corticosteroids with these patients. Methods This retrospective multicenter study screened 5447 confirmed COVID-19 patients hospitalized between Jan 1, 2021, to December 1, 2022, in three centers in India, where the prevalence of chronic HBV infection is moderate to high. Severe patients who had chronic HBV and acute SARS-CoV-2 infection were potentially eligible. The diagnosis of chronic HBV infection was based on positive testing for hepatitis B surface antigen (HBsAg) or HBV DNA during hospitalization and a medical history of chronic HBV infection. Severe patients (meeting one of the following criteria: respiratory rate &amp;gt; 30 breaths/min; severe respiratory distress; or SpO2 ≤ 93% on room air; or oxygen index &amp;lt; 300 mmHg) with COVID-19/HBV co-infection were identified. The bias of confounding variables on corticosteroid effects was minimized using a multivariable logistic regression model and inverse probability of treatment weighting (IPTW) based on the propensity score. Results The prevalence of HBV co-infection in COVID-19 patients was 4.1%. There were 105 patients with severe COVID-19/HBV co-infections (median age 62 years, 57.1% male). Fifty-five patients received corticosteroid treatment and 50 patients did not. In the multivariable analysis, corticosteroid therapy (OR, 6.32, 95% CI 1.17-34.24, P = 0.033) was identified as an independent risk factor for 28-day mortality. With IPTW analysis, corticosteroid treatment was associated with delayed SARS-CoV-2 viral RNA clearance (OR, 2.95, 95% CI 1.63-5.32, P &amp;lt; 0.001), increased risk of 28-day and in-hospital mortality (OR, 4.90, 95% CI 1.68-14.28, P = 0.004; OR, 5.64, 95% CI 1.95-16.30, P = 0.001, respectively), and acute liver injury (OR, 4.50, 95% CI 2.57-7.85, P &amp;lt; 0.001). Methylprednisolone dose per day and cumulative dose in non-survivors were significantly higher than in survivors. Conclusion In patients with severe COVID-19/HBV co-infection, corticosteroid treatment may be associated with an increased risk of 28-day and in-hospital mortality. Disclosures All Authors: No reported disclosures

Fast platelet recovery is associated with remission in primary immune thrombocytopenia

Objectives: We aimed to reveal predictors of response and response duration to steroid therapy in first line of treatment in immune thrombocytopenia (ITP). Methods: Fifty patients, who were diagnosed with ITP in hematology department of Suleyman Demirel University Hospital between 2005-2019, who had sufficient clinical and laboratory data, followed up for at least one year and received corticosteroid treatment in first line, were evaluated retrospectively for treatment response time, remission, prognosis on their first line treatment. The patients who maintained remission for more than 12 months was defined as group 1 and those who did not achieve remission or relapsed in less than 12 months were defined as group 2. Results: Twenty-two (44%) patients responded in first 3 days of the treatment, 16 (32%) patients in 4 to 7 days and 4 (8%) patients responded in more than 7 days. Eighty-four percent (n = 42) of these patients had complete response to corticosteroid treatment. When the remission maintenances were examined, it was observed that 22 (44%) patients were in remission for more than 12 months, 20 (40%) patients were in remission with treatment but relapsed before 12 months and 8 (16%) patients did not respond to corticosteroid treatment. When the response time to treatment in patients with or without remission was compared, remission was significantly lower in those who responded late to treatment (p = 0.01). When the response rates to corticosteroid treatment of patients in group 1 and 2 were evaluated, it was found that the response time to treatment was not related to the maintenance of remission (p = 0.267). Conclusions: Faster response time to treatment produced higher remission rates but, we could not find any relationship between response time to treatment and duration of remission.

During the Omicron Pandemic Wave, the Severe Systemic Inflammatory Status of COVID-19 Indicated a Higher Risk of In-Hospital Mortality and Mediated the Clinical Efficacy of Corticosteroids.

For the distinct immune/inflammatory responses from Omicron variant infection, this study aimed to investigate the diagnostic efficacy of systemic inflammatory indicators and the clinical efficacy of corticosteroids on the in-hospital mortality among COVID-19 patients. Under a retrospective cohort study, 1081 COVID-19 patients were recruited from Beijing Youan Hospital, Capital Medical University between November 16, 2022 and January 30, 2023. We chose neutrophil-to-lymphocyte ratio (NLR), CRP-to-lymphocyte ratio (CLR), and CRP-to-albumin ratio (CAR) as the systemic inflammatory indicators. Receiver operating curve (ROC) and multivariate logistic regression analysis were used to determine the diagnostic efficacy of systemic inflammatory indicators and the association between systemic inflammatory indicators and in-hospital mortality. Among 684 patients included in analysis, 96 died during hospitalization. NLR, CLR and CAR performed well (with an area under the curve (AUC) greater than 0.75) in discriminating in-hospital mortality among COVID-19 patients. The severe status of systemic inflammation, with optimal cut-off value derived from ROC analysis, significantly associated higher risk of in-hospital mortality (OR = 3.81 for NLR ≥ 6.131; OR = 3.76 for CLR ≥ 45.455; OR = 5.10 for CAR ≥ 1.436). Corticosteroids use within 72 hours of admission increased the in-hospital mortality 2.88-fold for COVID-19 patients. In the subgroup of patients with severe systemic inflammation, corticosteroids increased the risk of in-hospital mortality (OR = 2.11 for NLR, p = 0.055; OR = 2.94 for CLR, p = 0.005; OR = 2.31 for CAR, p = 0.036). Systemic inflammatory indicators had good diagnostic performance for in-hospital mortality. Patients with severe systemic inflammatory status should not receive corticosteroid treatment and further studies are warranted for confirmation.

The effect of corticosteroid use in septic shock on secondary infection frequency, microorganism species, morbidity, and mortality

&lt;b&gt;Aim:&lt;/b&gt; We aimed to examine the effect of corticosteroid treatment in vasopressor-refractory septic shock on secondary infections, microorganism species, survival, and length of hospital stay.&lt;br /&gt; &lt;b&gt;Material and methods: &lt;/b&gt;In this observational study, the records of 108 septic shock patients admitted to the intensive care unit (ICU) were reviewed.&lt;i&gt; &lt;/i&gt;Patients were divided into two groups: the corticosteroid group (Group S, n=60) and the non-corticosteroid group (Group S-0, n=48). The results of three cultures [blood, endotracheal aspirate (eta), urine, wound] taken after ICU admission were recorded. The groups were compared in terms of demographic characteristics, culture growth rates and microorganisms, length of hospital stay, and survival rates.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; The hospital (p=0.043) and ICU stay (p=0.035) were longer in Group S. There was no significant difference between the groups in terms of survival (p&amp;gt;0.05). The growth rate of the first urine culture was significantly higher in Group S-0 than in Group S (p=0.018), but there was no difference in terms of microorganism species (p&amp;gt;0.05). There was no significant difference in growth rates and microorganism species in blood, eta and wound cultures (p&amp;gt;0.05), but increase in growth rates were observed in the 2nd and 3rd eta and, wound cultures compared to first culture in Group S (p&amp;lt;0.05).&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; There was no difference between the patients who received and did not receive corticosteroid treatment in septic shock in terms of culture growth rates, growing microorganism species and mortality; however, the frequency of growth in eta and wound cultures increased and the length of hospital stay was longer in patients who received corticosteroids.

Case Report Recurrent Painful Ophthalmoplegic Neuropathy

This is a case report of recurrent painful ophthalmoplegic neuropathy (RPON), a rare disorder characterized by recurrent unilateral headaches and paralysis of the ocular cranial nerves. The condition was previously referred to as ophthalmoplegic migraine but was renamed due to potential misinterpretation of its underlying mechanisms. The case involves a 16-year-old female patient treated at the Hospital do Servidor Público Estadual de São Paulo. She experienced episodes of headache, periorbital pain, and cranial nerve paresis. Neurological examinations and imaging tests ruled out other causes. After diagnosis of RPON was considered, the patient received corticosteroid treatment. This article case report discusses the diagnostic criteria, clinical features, atypical aspects of the case, diagnostic challenges, treatment options, and the unresolved pathophysiology of RPON. Since RPON is a rare syndrome, research relies on observational studies and case reports like the one presented to enhance understanding and treatment approaches.