PMID- 36744291
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230228
IS  - 2772-6096 (Electronic)
IS  - 2772-6096 (Linking)
VI  - 5
DP  - 2023 Mar
TI  - Steroid exposure and outcome in COVID-19 pneumonia.
PG  - 100128
LID - 10.1016/j.bjao.2023.100128 [doi]
LID - 100128
AB  - BACKGROUND: Corticosteroids are used to treat COVID-19 pneumonia. However, the 
      optimal dose is unclear. This study describes the association between 
      corticosteroid exposure with disease severity and outcome in COVID-19 pneumonia. 
      METHODS: This is a single-centre retrospective, observational study including 
      adult ICU patients who received systemic corticosteroids for COVID-19 pneumonia 
      between March 2020 and March 2021. We recorded patient characteristics, disease 
      severity, total steroid exposure, respiratory support and gas exchange data, and 
      90-day mortality. RESULTS: We included 362 patients. We allocated patients to 
      groups with increasing disease severity according to the highest level of 
      respiratory support that they received: high-flow nasal oxygen or continuous 
      positive airway pressure (HFNO/CPAP) in 12.7%, invasive mechanical ventilation 
      (IMV) in 61.6%, and extracorporeal membrane oxygenation (ECMO) in 25.7%. For 
      these three groups, the median (inter-quartile range [IQR]) age was 61 (54-71) vs 
      58 (50-66) vs 46 (38-53) yr, respectively (P<0.001); median (IQR) APACHE (Acute 
      Physiology and Chronic Health Evaluation) II scores were 12 (9-15) vs 14 (12-18) 
      vs 15 (12-17), respectively (P=0.006); the median (IQR) lowest PaO2 /FiO(2) ratio 
      was 15.1 (11.8-21.7) vs 15.1 (10.7-22.2) vs 9.5 (7.9-10.9) kPa, respectively 
      (P<0.001). Ninety-day mortality was 9% vs 27% vs 37% (P=0.002). Median (IQR) 
      dexamethasone-equivalent exposure was 37 (24-62) vs 174 (86-504) vs 535 
      (257-1213) mg (P<0.001). 'Pulsed' steroids were administered to 26% of the IMV 
      group and 48% of the ECMO group. Patients with higher disease severity who 
      received pulse steroids had a higher 90-day mortality. CONCLUSIONS: 
      Corticosteroid exposure increased with the severity of COVID-19 pneumonia. Pulsed 
      dose steroids were used more frequently in patients receiving greater respiratory 
      support. Future studies should address patient selection and outcomes associated 
      with pulsed dose steroids in patients with severe and deteriorating COVID-19 
      pneumonia.
CI  - (c) 2023 The Author(s).
FAU - Remmington, Christopher
AU  - Remmington C
AD  - Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
AD  - Institute of Pharmaceutical Science, King's College London, London, UK.
FAU - Barrett, Nicholas A
AU  - Barrett NA
AD  - Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, 
      London, UK.
AD  - Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & 
      Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, 
      London, UK.
FAU - Agarwal, Sangita
AU  - Agarwal S
AD  - Department of Rheumatology and Guy's and St Thomas' NHS Foundation Trust, London, 
      UK.
FAU - Lams, Boris
AU  - Lams B
AD  - Department of Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, 
      London, UK.
FAU - Collins, Patrick
AU  - Collins P
AD  - Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, 
      London, UK.
FAU - Camarda, Valentina
AU  - Camarda V
AD  - Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, 
      London, UK.
FAU - Meadows, Chris
AU  - Meadows C
AD  - Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, 
      London, UK.
FAU - Hanks, Fraser
AU  - Hanks F
AD  - Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
FAU - Sanderson, Barnaby
AU  - Sanderson B
AD  - Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, 
      London, UK.
FAU - Retter, Andrew
AU  - Retter A
AD  - Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, 
      London, UK.
FAU - Camporota, Luigi
AU  - Camporota L
AD  - Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, 
      London, UK.
AD  - Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & 
      Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, 
      London, UK.
LA  - eng
PT  - Journal Article
DEP - 20230131
PL  - England
TA  - BJA Open
JT  - BJA open
JID - 9918419157906676
PMC - PMC9886648
OTO - NOTNLM
OT  - COVID-19
OT  - acute respiratory distress syndrome
OT  - corticosteroid
OT  - mechanical ventilation
OT  - steroid
COIS- The authors declare they have no conflicts of interest.
EDAT- 2023/02/07 06:00
MHDA- 2023/02/07 06:01
PMCR- 2023/01/31
CRDT- 2023/02/06 04:08
PHST- 2022/12/03 00:00 [received]
PHST- 2023/01/12 00:00 [revised]
PHST- 2023/01/23 00:00 [accepted]
PHST- 2023/02/07 06:00 [pubmed]
PHST- 2023/02/07 06:01 [medline]
PHST- 2023/02/06 04:08 [entrez]
PHST- 2023/01/31 00:00 [pmc-release]
AID - S2772-6096(23)00006-0 [pii]
AID - 100128 [pii]
AID - 10.1016/j.bjao.2023.100128 [doi]
PST - ppublish
SO  - BJA Open. 2023 Mar;5:100128. doi: 10.1016/j.bjao.2023.100128. Epub 2023 Jan 31.