Use of glucocorticoids megadoses in SARS-CoV-2 infection in a spanish registry: SEMI-COVID-19

DOI record: { "DOI": "10.1371/journal.pone.0261711", "ISSN": [ "1932-6203" ], "URL": "http://dx.doi.org/10.1371/journal.pone.0261711", "abstract": "<jats:sec id=\"sec001\">\n<jats:title>Objective</jats:title>\n<jats:p>To describe the impact of different doses of corticosteroids on the evolution of patients with COVID-19 pneumonia, based on the potential benefit of the non-genomic mechanism of these drugs at higher doses.</jats:p>\n</jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods</jats:title>\n<jats:p>Observational study using data collected from the SEMI-COVID-19 Registry. We evaluated the epidemiological, radiological and analytical scenario between patients treated with megadoses therapy of corticosteroids vs low-dose of corticosteroids and the development of complications. The primary endpoint was all-cause in-hospital mortality according to use of corticosteroids megadoses.</jats:p>\n</jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results</jats:title>\n<jats:p>Of a total of 14,921 patients, corticosteroids were used in 5,262 (35.3%). Of them, 2,216 (46%) specifically received megadoses. Age was a factor that differed between those who received megadoses therapy versus those who did not in a significant manner (69 years [IQR 59–79] vs 73 years [IQR 61–83]; <jats:italic>p</jats:italic> &lt; .001). Radiological and analytical findings showed a higher use of megadoses therapy among patients with an interstitial infiltrate and elevated inflammatory markers associated with COVID-19. In the univariate study it appears that steroid use is associated with increased mortality (OR 2.07 95% CI 1.91–2.24 p &lt; .001) and megadose use with increased survival (OR 0.84 95% CI 0.75–0.96, p 0.011), but when adjusting for possible confounding factors, it is observed that the use of megadoses is also associated with higher mortality (OR 1.54, 95% CI 1.32–1.80; p &lt; .001). There is no difference between megadoses and low-dose (p .298). Although, there are differences in the use of megadoses versus low-dose in terms of complications, mainly infectious, with fewer pneumonias and sepsis in the megadoses group (OR 0.82 95% CI 0.71–0.95; p &lt; .001 and OR 0.80 95% CI 0.65–0.97; p &lt; .001) respectively.</jats:p>\n</jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion</jats:title>\n<jats:p>There is no difference in mortality with megadoses versus low-dose, but there is a lower incidence of infectious complications with glucocorticoid megadoses.</jats:p>\n</jats:sec>", "author": [ { "ORCID": "http://orcid.org/0000-0002-3537-8607", "affiliation": [], "authenticated-orcid": true, "family": "Lavilla Olleros", "given": "Cristina", "sequence": "first" }, { "affiliation": [], "family": "Ausín García", "given": "Cristina", "sequence": "additional" }, { "affiliation": [], "family": "Bendala Estrada", "given": "Alejandro David", "sequence": "additional" }, { "affiliation": [], "family": "Muñoz", "given": "Ana", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-6329-0311", "affiliation": [], "authenticated-orcid": true, "family": "Wikman Jogersen", "given": "Philip Erick", "sequence": "additional" }, { "affiliation": [], "family": "Fernández Cruz", "given": "Ana", "sequence": "additional" }, { "affiliation": [], "family": "Giner Galvañ", "given": "Vicente", "sequence": "additional" }, { "affiliation": [], "family": "Vargas", "given": "Juan Antonio", "sequence": "additional" }, { "affiliation": [], "family": "Seguí Ripoll", "given": "José Miguel", "sequence": "additional" }, { "affiliation": [], "family": "Rubio-Rivas", "given": "Manuel", "sequence": "additional" }, { "affiliation": [], "family": "Miranda Godoy", "given": "Rodrigo", "sequence": "additional" }, { "affiliation": [], "family": "Mérida Rodrigo", "given": "Luis", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0003-0578-7474", "affiliation": [], "authenticated-orcid": true, "family": "Fonseca Aizpuru", "given": "Eva", "sequence": "additional" }, { "affiliation": [], "family": "Arnalich Fernández", "given": "Francisco", "sequence": "additional" }, { "affiliation": [], "family": "Artero", "given": "Arturo", "sequence": "additional" }, { "affiliation": [], "family": "Loureiro Amigo", "given": "Jose", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-3691-1637", "affiliation": [], "authenticated-orcid": true, "family": "García García", "given": "Gema María", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0003-0151-5420", "affiliation": [], "authenticated-orcid": true, "family": "Corral Gudino", "given": "Luis", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0001-7588-9148", "affiliation": [], "authenticated-orcid": true, "family": "Jiménez Torres", "given": "Jose", "sequence": "additional" }, { "affiliation": [], "family": "Casas-Rojo", "given": "José-Manuel", "sequence": "additional" }, { "affiliation": [], "family": "Millán Núñez-Cortés", "given": "Jesús", "sequence": "additional" }, { "affiliation": [], "name": "On behalf of the SEMI-COVID-19 Network", "sequence": "additional" } ], "container-title": [ "PLOS ONE" ], "content-domain": { "crossmark-restriction": false, "domain": [ "www.plosone.org" ] }, "created": { "date-parts": [ [ 2022, 1, 21 ] ], "date-time": "2022-01-21T19:40:51Z", "timestamp": 1642794051000 }, "deposited": { "date-parts": [ [ 2022, 1, 21 ] ], "date-time": "2022-01-21T19:41:24Z", "timestamp": 1642794084000 }, "editor": [ { "affiliation": [], "family": "Zivkovic", "given": "Aleksandar R.", "sequence": "first" } ], "indexed": { "date-parts": [ [ 2022, 1, 21 ] ], "date-time": "2022-01-21T20:11:44Z", "timestamp": 1642795904653 }, "is-referenced-by-count": 0, "issn-type": [ { "type": "electronic", "value": "1932-6203" } ], "issue": "1", "issued": { "date-parts": [ [ 2022, 1, 21 ] ] }, "journal-issue": { "issue": "1", "published-online": { "date-parts": [ [ 2022, 1, 21 ] ] } }, "language": "en", "license": [ { "URL": "http://creativecommons.org/licenses/by/4.0/", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2022, 1, 21 ] ], "date-time": "2022-01-21T00:00:00Z", "timestamp": 1642723200000 } } ], "link": [ { "URL": "https://dx.plos.org/10.1371/journal.pone.0261711", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "340", "original-title": [], "page": "e0261711", "prefix": "10.1371", "published": { "date-parts": [ [ 2022, 1, 21 ] ] }, "published-online": { "date-parts": [ [ 2022, 1, 21 ] ] }, "publisher": "Public Library of Science (PLoS)", "reference": [ { "DOI": "10.1056/NEJMoa2001017", "article-title": "A Novel Coronavirus from Patients with Pneumonia in China, 2019", "author": "N Zhu", "doi-asserted-by": "crossref", "first-page": "727", "issue": "8", "journal-title": "N Engl J Med", "key": "pone.0261711.ref001", "volume": "382", "year": "2020" }, { "key": "pone.0261711.ref002", "unstructured": "S. 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