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Impact of corticosteroid doses on prognosis of severe and critical COVID-19 patients with Omicron variant infection: a propensity score matching study

Wang et al., Inflammopharmacology, doi:10.1007/s10787-024-01520-0
Aug 2024  
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Mortality -23% Improvement Relative Risk Corticosteroids  Wang et al.  LATE TREATMENT Is late treatment with corticosteroids beneficial for COVID-19? PSM retrospective 780 patients in China (November 2022 - February 2023) Higher mortality with corticosteroids (p=0.028) c19early.org Wang et al., Inflammopharmacology, Aug 2024 Favorshigh dose Favorslow dose 0 0.5 1 1.5 2+
Retrospective 1,167 severe/critical COVID-19 patients in China showing higher 28-day mortality with higher doses of corticosteroids (>50mg/day prednisone equivalent) compared to usual doses (30-50mg/day). The type of corticosteroid used did not affect outcomes. Authors suggest that higher doses of corticosteroids may lead to poorer prognosis for severe/critical COVID-19 patients with Omicron infection in the ICU, possibly due to a milder inflammatory response with Omicron.
risk of death, 23.4% higher, HR 1.23, p = 0.03, treatment 260, control 520, adjusted per study, propensity score matching, multivariable, Cox proportional hazards.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Wang et al., 9 Aug 2024, retrospective, China, peer-reviewed, 14 authors, study period 1 November, 2022 - 11 February, 2023. Contact: drzhanqy@163.com.
This PaperMiscellaneousAll
Impact of corticosteroid doses on prognosis of severe and critical COVID-19 patients with Omicron variant infection: a propensity score matching study
Shiyao Wang, Ziying Chen, Xinran Zhang, Xiaojing Wu, Yuqiong Wang, Qi Zhang, Linna Huang, Xiaoyang Cui, Ying Cai, Xu Huang, Jingen Xia, Sichao Gu, Min Li, Qingyuan Zhan
Inflammopharmacology, doi:10.1007/s10787-024-01520-0
Background There is lack of research on corticosteroid use for severe and critical COVID-19 patients with Omicron variant infection. Methods This multi-center retrospective cohort study involved 1167 patients from 59 ICUs across the mainland of China diagnosed with severe or critical SARS-CoV-2 Omicron variant infection between November 1, 2022, and February 11, 2023. Patients were segregated into two groups based on their corticosteroid treatment-usual dose (equivalent prednisone dose 30-50 mg/day) and higher dose (equivalent prednisone dose > 50 mg/day). The primary outcome was 28-day ICU mortality. Propensity score matching was used to compare outcomes between cohorts. Results After propensity score matching, 520 patients in the usual dose corticosteroid group and 260 patients in the higher dose corticosteroid group were included in the analysis, respectively. The mortality was significantly higher in the higher dose corticosteroid group (67.3%, 175/260) compared to the usual dose group (56.0%, 291/520). Logistic regression showed that higher doses of corticosteroids were significantly associated with increased mortality at 28-day (OR = 1.62,95% CI 1.19-2.21, p = 0.002) and mortality in ICU stay (OR = 1.66,95% CI 1.21-2.28, p = 0.002). Different types of corticosteroids did not affect the effect. Conclusions The study suggests that higher-dose corticosteroids may lead to a poorer prognosis for severe and critical COVID-19 patients with Omicron variant infection in the ICU. Further research is needed to determine the appropriate corticosteroid dosage for these patients.
Author contributions SW, ZC and QZ conceived of the study. SW, XW and QZ participated in the design of the study and coordination. LH, XC, YC, XH, JX, SG, and ML participated in the enrolment of the cases. SW, ZC, YW, and QZ participated in the data collection. SW, XZ performed the statistical analysis. SW drafted the manuscript. All authors read and approved the final manuscript. Declarations Ethics approval The study protocol was approved by the Research Ethics Commission of China-Japan Friendship Hospital (2019-79-K51-1) . This study was performed in accordance with the Declaration of Helsinki. Conflict of interests The authors have no relevant financial or nonfinancial interests to disclose. Consent to participate Written informed consent was waived. Consent to publish Not applicable. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted..
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' 'Retrieved 13 January 2023, from ' 'https://apps.who.int/iris/rest/bitstreams/1449398/retrieve'}, { 'key': '1520_CR23', 'volume': '83', 'author': 'A Piralla', 'year': '2023', 'unstructured': 'Piralla A, Mojoli F, Pellegrinelli L, Ceriotti F, Valzano A, Grasselli G ' 'et al (2023) Impact of SARS-CoV-2 Omicron and Delta variants in patients ' 'requiring intensive care unit (ICU) admission for COVID-19, Northern ' 'Italy, December 2021 to January 2022. Respir Med Res 83:100990', 'journal-title': 'Respir Med Res'}, { 'issue': '3', 'key': '1520_CR24', 'doi-asserted-by': 'publisher', 'first-page': '304', 'DOI': '10.1007/s00134-017-4683-6', 'volume': '43', 'author': 'A Rhodes', 'year': '2017', 'unstructured': 'Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R et al ' '(2017) Surviving sepsis campaign: international guidelines for ' 'management of sepsis and septic shock: 2016. Intensive Care Med ' '43(3):304–377', 'journal-title': 'Intensive Care Med'}, { 'key': '1520_CR25', 'doi-asserted-by': 'publisher', 'DOI': '10.1183/13993003.00025-2022', 'author': 'C Salvarani', 'year': '2022', 'unstructured': 'Salvarani C, Massari M, Costantini M, Merlo DF, Mariani GL, Viale P et ' 'al (2022) Intravenous methylprednisolone pulses in hospitalised patients ' 'with severe COVID-19 pneumonia: a double-blind, randomised, ' 'placebo-controlled trial. Eur Respir J. ' 'https://doi.org/10.1183/13993003.00025-2022', 'journal-title': 'Eur Respir J'}, { 'issue': '8', 'key': '1520_CR26', 'doi-asserted-by': 'publisher', 'first-page': '2230', 'DOI': '10.1053/j.gastro.2019.02.002', 'volume': '156', 'author': 'T Shen', 'year': '2019', 'unstructured': 'Shen T, Liu Y, Shang J, Xie Q, Li J, Yan M et al (2019) Incidence and ' 'etiology of drug-induced liver injury in mainland China. ' 'Gastroenterology 156(8):2230-2241.e2211', 'journal-title': 'Gastroenterology'}, { 'issue': '13', 'key': '1520_CR27', 'doi-asserted-by': 'publisher', 'first-page': '1330', 'DOI': '10.1001/jama.2020.17023', 'volume': '324', 'author': 'JAC Sterne', 'year': '2020', 'unstructured': 'Sterne JAC, Murthy S, Diaz JV, Slutsky AS, Villar J, Angus DC et al ' '(2020) Association between administration of systemic corticosteroids ' 'and mortality among critically ill patients with covid-19: a ' 'meta-analysis. 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JAMA 324(13):1307–1316', 'journal-title': 'JAMA'}, { 'issue': '1', 'key': '1520_CR29', 'doi-asserted-by': 'publisher', 'first-page': '229', 'DOI': '10.1007/s43440-021-00341-0', 'volume': '74', 'author': 'N Toroghi', 'year': '2022', 'unstructured': 'Toroghi N, Abbasian L, Nourian A, Davoudi-Monfared E, Khalili H, ' 'Hasannezhad M et al (2022) Comparing efficacy and safety of different ' 'doses of dexamethasone in the treatment of COVID-19: a three-arm ' 'randomized clinical trial. Pharmacol Rep 74(1):229–240', 'journal-title': 'Pharmacol Rep'}, { 'issue': '7', 'key': '1520_CR30', 'doi-asserted-by': 'publisher', 'first-page': '934', 'DOI': '10.1001/jamainternmed.2020.0994', 'volume': '180', 'author': 'C Wu', 'year': '2020', 'unstructured': 'Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S et al (2020) Risk factors ' 'associated with acute respiratory distress syndrome and death in ' 'patients with coronavirus disease 2019 pneumonia in Wuhan. China JAMA ' 'Intern Med 180(7):934–943', 'journal-title': 'China JAMA Intern Med'}, { 'issue': '1', 'key': '1520_CR31', 'doi-asserted-by': 'publisher', 'first-page': '349', 'DOI': '10.1002/jmv.27351', 'volume': '94', 'author': 'H Yaqoob', 'year': '2022', 'unstructured': 'Yaqoob H, Greenberg D, Hwang F, Lee C, Vernik D, Manglani R et al (2022) ' 'Comparison of pulse-dose and high-dose corticosteroids with no ' 'corticosteroid treatment for COVID-19 pneumonia in the intensive care ' 'unit. 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Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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