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Available online 5 March 2024
Association between different corticosteroid regimens used in severe SARS-CoV-2 infection and short-term mortality: retrospective cohort study
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
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A. González-Castro
Corresponding author
e409@humv.es

Corresponding author.
, A. Fernandez, E. Cuenca-Fito, Y. Peñasco, J. Ceña, J.C. Rodríguez Borregán
Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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Received 22 December 2022. Accepted 04 September 2023
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Tables (3)
Table 1. Baseline clinical-epidemiological characteristicsof patients admitted with confirmed SARS-CoV-2 pneumonia.
Table 2. Main basic clinical differences between the four groups analysed in the study.
Table 3. Data from the Cox proportional hazards regression model in the study of risk factors for 28-day ICU mortality, introducing variables with a p-value of <.1 in the bivariate analysis against 28-day morality.
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Abstract
Introduction

During 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.

Method

Observational, 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.

Results

Data 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).

Conclusions

The 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.

Keywords:
Dexamethasone
Methylprednisolone
SARS-CoV-2
Covid
28-day mortality
Resumen
Introducción

Durante la pandemia por SARS-CoV-2, varias pautas de corticoides han sido utilizadas en el tratamiento de la enfermedad, con resultados dispares según fármaco y pauta utilizada. Por este motivo hemos querido analizar diferencias en la mortalidad temprana derivadas del empleo de diferentes pautas de dexametasona y metilprednisolona en infección por SARS-CoV-2 en pacientes graves que requieren ingreso en una unidad de cuidados intensivos (UCI).

Método

Estudio observacional, analítico y retrospectivo llevado a cabo en una unidad de cuidados intensivos de un hospital universitario de tercer nivel, entre marzo de 2020 y junio de 2021. Se incluyeron pacientes adultos (>18 años) que ingresaron de forma consecutiva debido a una infección confirmada por el virus SARS-CoV-2. Se evaluó la asociación entre diferentes pautas de corticoides utilizadas y la mortalidad en la UCI a los 28 días mediante un modelo de regresión de riesgos proporcionales de Cox.

Resultados

Cohorte de 539 pacientes donde la edad de los pacientes mostró una asociación significativa con la mortalidad a los 28 días en la UCI (RR: 1,06; IC 95%: 1,02-1,10; p<0,01). Al analizar las diferentes pautas de corticoides utilizadas, se identificó una posible tendencia en la asociación entre la dosis de dexametasona de 6mg/día y una menor mortalidad a los 28 días en la UCI, con un RR de 0,40 (IC 95%: 0,15-1,02; p=0,05). Por otro lado, las dosis de dexametasona mayores a 6mg/día y las dosis bajas de metilprednisolona mostraron una tendencia a reducir la mortalidad, aunque no alcanzaron significación estadística (RR: 0,54; IC 95%: 0,21-1,37; p=0,19 y RR: 0,51; IC 95%: 0,20-1,27; p=0,15, respectivamente).

Conclusiones

El estudio sugiere que la edad y la dosis de dexametasona de 6mg/día podrían ser factores importantes en la mortalidad a los 28 días en pacientes con infección por SARS-CoV-2 en UCI.

Palabras clave:
Dexametasona
Metilprednisolona
SARS-CoV-2
COVID-19
Mortalidad a corto plazo

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