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Inicio Medicina Clínica (English Edition) Effectiveness of glucocorticoids in patients hospitalized for severe SARS-CoV-2 ...
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Vol. 156. Issue 5.
Pages 221-228 (March 2021)
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Vol. 156. Issue 5.
Pages 221-228 (March 2021)
Original article
Effectiveness of glucocorticoids in patients hospitalized for severe SARS-CoV-2 pneumonia
Efectividad de los glucocorticoides en pacientes hospitalizados por neumonía grave por SARS-CoV-2
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288
José Francisco Pascual Parejaa,b,
Corresponding author
Rebeca García-CaballeroaLlanos Soler Rangela,bMiguel Angel Vázquez-Rondaa,bSilvia Roa FrancoaGema Navarro JiménezaMiguel Angel Moreno Palancoa,bPatricia González-Ruanoa,bRamiro López-MenchacaaPilar Ruíz-Secoa,bBárbara Pagán MuñozaAlejandro Gómez GómezaBeatriz Pérez-MonteaRebeca Fuerte MartínezaJose Luis Valle LópezaArturo Muñoz BlancoaIsabel Rábago LoriteaPatricia Martínez MartínaGonzalo Serralta San Martína,bJorge Francisco Gómez-Cerezoa,bHUIS-COVID-19 working group
a Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
b Universidad Europea de Madrid Villaviciosa de Odón, Madrid, Spain
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Figures (1)
Tables (3)
Table 1. Patient characteristics.
Table 2. Factors associated with unfavourable course (admission to ICU or death).
Table 3. Comparative analyses between different treatments with or without glucocorticoids and the association with unfavourable outcomes (admission to the ICU or death).
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Abstract
Background

Several studies have reported the beneficial effect of glucocorticoids in the treatment of cytokine storm that occurs in patients with severe COVID-19. Various glucocorticoids regimens have been proposed.

Methods

Retrospective observational study that includes patients with severe SARS-CoV-2 pneumonia and compares admission to an Intensive Care Unit (ICU) or death during hospitalization in three groups of patients: no glucocorticoids treatment, use of glucocorticoids doses equivalent to less than 250 mg of prednisone daily and use of equivalent doses greater than or equal to 250 mg of prednisone daily. Multivariate analysis was performed using logistic regression, using the propensity index as a covariant.

Results

Of the 259 patients enrolled in the study, 67 (25.9%) had an unfavorable evolution, dying or requiring ICU admission. Comparative analyzes between different glucocorticoids treatments and the association with ICU admission or death were: glucocorticoids treatment (any dose) versus no glucocorticoids treatment (OR: 0.71 [0.30–1.66]), treatment with glucocorticoids (≥250 mg prednisone daily) versus no glucocorticoids treatment (OR: 0.35 [0.11–1.08]) and glucocorticoids treatment (≥250 mg prednisone daily) versus patients with glucocorticoids doses <250 mg prednisone daily or without glucocorticoids treatment (OR: 0.30 [0.10–0.88]).

Conclusion

The results of this study show that patients with severe SARS-CoV-2 pneumonia treated with glucocorticoids pulses with equivalent doses of prednisone greater than or equal to 250 mg have a more favorable evolution (less mortality and less admission to ICU).

Keywords:
Corticosteroids
Coronavirus infection disease 2019 (COVID-19)
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Propensity index
Resumen
Introducción

Se han comunicado varios trabajos donde se ha demostrado un efecto beneficioso de los glucocorticoides como tratamiento de la tormenta de citocinas que se asocia a los cuadros graves por SARS-CoV-2, plateándose diferentes pautas de glucocorticoides.

Métodos

Estudio observacional retrospectivo que incluye pacientes con neumonía grave por SARS-CoV-2 y compara el ingreso en una unidad de cuidados intensivos (UCI) o fallecimiento durante la hospitalización en 3 grupos de pacientes: sin tratamiento con glucocorticoides, uso de dosis diarias de glucocorticoides equivalentes menores a 250 mg de prednisona y dosis diarias equivalentes mayores o iguales a 250 mg de prednisona. Se realizó un análisis multivariante mediante regresión logística, utilizando el índice de propensión como covariante.

Resultados

De los 259 pacientes incorporados al estudio 67 (25,9%) tuvieron una evolución desfavorable, falleciendo o precisando ingreso en UCI. Los análisis comparativos entre diferentes tratamientos con glucocorticoides, y la asociación con ingreso en UCI o fallecimiento fueron: tratamiento con glucocorticoides (cualquier dosis) versus sin tratamiento con glucocorticoides (OR: 0,71 [0,30–1,66]), tratamiento con glucocorticoides (≥250 mg de prednisona al día) versus sin tratamiento con glucocorticoides (OR: 0,35 [0,11–1,08]) y tratamiento con glucocorticoides (≥250 mg de prednisona al día) versus pacientes con dosis de glucocorticoides < 250 mg de prednisona o sin tratamiento con glucocorticoides (OR: 0,30 [0,10–0,88]).

Conclusión

Los resultados de este estudio muestran que los paciente con neumonía grave por SARS-CoV-2 tratados con pulsos con glucocorticoides con dosis equivalentes de prednisona mayor o igual de 250 mg tienen una evolución más favorable (menos mortalidad e ingreso en UCI).

Palabras clave:
Corticoides
Enfermedad por coronavirus 2019 (COVID-19)
Síndrome agudo respiratorio severo por coronavirus 2 (SARS-CoV-2)
Índice de propensión

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