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Corticosteroids for hospitalized patients with severe/critical COVID-19: a retrospective study in Chongqing, China

Zhuang et al., Scientific Reports, doi:10.1038/s41598-024-75926-9
Oct 2024  
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Mortality -5% Improvement Relative Risk Corticosteroids  Zhuang et al.  LATE TREATMENT Is late treatment with corticosteroids beneficial for COVID-19? PSM retrospective 174 patients in China (December 2022 - January 2023) No significant difference in mortality c19early.org Zhuang et al., Scientific Reports, Oct 2024 Favorscorticosteroids Favorscontrol 0 0.5 1 1.5 2+
Retrospective 406 hospitalized severe/critical COVID-19 patients in China showing no significant difference in 28-day mortality with corticosteroid treatment (methylprednisolone, dexamethasone, or both). Corticosteroids were associated with a longer survival time among non-survivors. The study found high overall mortality of 33% in-hospital and 38% at 28 days in this severe/critical, mostly elderly population with high comorbidities during the omicron wave in 2022-2023. Authors hypothesize that the potential benefits of corticosteroids may be limited by the timing of administration and the biphasic effects of suppressing both viral replication and inflammation.
risk of death, 4.7% higher, HR 1.05, p = 0.86, treatment 37 of 87 (42.5%), control 34 of 87 (39.1%), adjusted per study, propensity score matching, multivariable, Cox proportional hazards.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Zhuang et al., 16 Oct 2024, retrospective, China, peer-reviewed, median age 76.0, 13 authors, study period December 2022 - January 2023. Contact: guoshul666@163.com.
This PaperMiscellaneousAll
Corticosteroids for hospitalized patients with severe/critical COVID-19: a retrospective study in Chongqing, China
Rongjuan Zhuang, Hongli Xia, Li Xu, Zhiqiang Liu, Kaican Zong, Hailang Peng, Bin Liu, Huizi Wu, Lan Huang, Hongwei Yang, Chun Luo, Yuting Yin, Shuliang Guo
Scientific Reports, doi:10.1038/s41598-024-75926-9
Corticosteroids have always been recommended for severe cases of COVID-19. However, the efficacy of treatment with corticosteroids for COVID-19 during the SARS-CoV-2 omicron outbreak in China has not been reported. Clinical data from 406 patients hospitalized for severe/critical COVID-19 from December 2022 to January 2023 at six hospitals in Chongqing were retrospectively analyzed. The primary outcome was all-cause mortality at 28 days in the groups with and without corticosteroids treatment after propensity score matching (PSM). Secondary outcomes were to compare in-hospital mortality and length of survival time with corticosteroids and those without corticosteroids. This study included 406 patients with severe or critical COVID-19, divided into the corticosteroids group (231, 56.9%) and non-corticosteroids group (175, 43.1%). After PSM, the use of corticosteroids did not reduce all-cause mortality at 28 days (42.5% vs. 39.1%). Univariate analysis showed that corticosteroids were not associated with improved all-cause mortality at 28 days [hazard ratio (HR), 1.019; 95% confidence interval (CI), 0.639-1.623; p = 0.938]. Multivariate analysis showed similar results (HR, 1.047; 95% CI, 0.633-1.732; p = 0.858). Among non-survivors, the survival time was significantly larger in those who received corticosteroids compared with the non-corticosteroid users [median 13 (IQR 6.5-15.5) vs. 6 (4-11.25), p = 0.007]. The use of systemic corticosteroids in severe/critical COVID-19 may provide certain potential survival benefits but does not improve prognosis.
Author contributions R.Z. and H.X. participated in the study design. Z.L., K.Z., H.P., B.L., H.W., L.H., H.Y., C.L., and Y.Y. collected the epidemiological and clinical data. R.Z. and H.X. performed the statistical analysis and drafted the manuscript. L.X. Conducted the literature search and data extraction. S.G. revised the final manuscript. All authors reviewed and approved the final version of the manuscript. Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki. The study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (K2023-066). The institutional review board of the First Affiliated Hospital of Chongqing Medical University, Jinshan Campus of the First Affiliated Hospital of Chongqing Medical University, The Seventh People's Hospital of Chongqing, People's Hospital of Shapingba District, Affiliated University Town Hospital of Chongqing Medical University and Chongqing University Three Gorges Hospital approved the analysis of patients' clinical and radiological data. Because of the retrospective nature of the study, the requirement for informed consent was waived by the Medical Ethics Committee of the First Affiliated Hospital of Chongqing Medical University. The data were deidentified and only then transferred for analysis. Consent for publication All authors have accepted responsibility for the entire content of this manuscript and..
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Biswa Mohan Padhy, null Effectiveness of ' 'pulse dose methyl prednisolone in management of COVID 19: A systematic ' 'review and meta-analysis of observational studies. Journal of Pharmacy & ' 'Pharmaceutical Sciences: A Publication of the Canadian Society for ' 'Pharmaceutical Sciences, Societe Canadienne Des Sciences Pharmaceutiques ' '25, 110–123 (2022).', 'DOI': '10.18433/jpps32430'}, { 'key': '75926_CR39', 'doi-asserted-by': 'publisher', 'first-page': 'e13881', 'DOI': '10.1111/eci.13881', 'volume': '53', 'author': 'L Corral-Gudino', 'year': '2023', 'unstructured': 'Corral-Gudino, L. et al. Effect of intravenous pulses of ' 'methylprednisolone 250\xa0mg versus dexamethasone 6\xa0mg in ' 'hospitalised adults with severe COVID-19 pneumonia: an open-label ' 'randomised trial. Eur. J. Clin. Invest. 53, e13881 (2023).', 'journal-title': 'Eur. J. Clin. Invest.'}, { 'key': '75926_CR40', 'doi-asserted-by': 'publisher', 'first-page': '580', 'DOI': '10.1007/s00134-022-06677-2', 'volume': '48', 'author': 'A Granholm', 'year': '2022', 'unstructured': 'Granholm, A. et al. Long-term outcomes of dexamethasone 12\xa0mg versus ' '6\xa0mg in patients with COVID-19 and severe hypoxaemia. Intensive Care ' 'Med. 48, 580–589 (2022).', 'journal-title': 'Intensive Care Med.'}, { 'key': '75926_CR41', 'doi-asserted-by': 'publisher', 'first-page': '491', 'DOI': '10.1177/08850666211066799', 'volume': '37', 'author': 'LP Maskin', 'year': '2022', 'unstructured': 'Maskin, L. P. et al. High- Versus Low-Dose Dexamethasone for the ' 'treatment of COVID-19-Related Acute Respiratory Distress Syndrome: a ' 'Multicenter, Randomized Open-label clinical trial. J. Intensive Care ' 'Med. 37, 491–499 (2022).', 'journal-title': 'J. 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T., Gcilitshana, O. & Pohl, C. H. Risk factors for fungal ' 'co-infections in critically ill COVID-19 patients, with a focus on ' 'immunosuppressants. J. Fungi (Basel Switzerland). 7, 545 (2021).', 'journal-title': 'J. Fungi (Basel Switzerland)'}, { 'key': '75926_CR47', 'doi-asserted-by': 'publisher', 'first-page': '1080822', 'DOI': '10.3389/fimmu.2022.1080822', 'volume': '13', 'author': 'CO Morton', 'year': '2022', 'unstructured': 'Morton, C. O., Griffiths, J. S., Loeffler, J., Orr, S. & White, P. L. ' 'Defective antifungal immunity in patients with COVID-19. Front. Immunol. ' '13, 1080822 (2022).', 'journal-title': 'Front. Immunol.'}, { 'key': '75926_CR48', 'doi-asserted-by': 'publisher', 'first-page': 'e465', 'DOI': '10.1016/S2665-9913(20)30170-3', 'volume': '2', 'author': 'G De Luca', 'year': '2020', 'unstructured': 'De Luca, G. et al. GM-CSF blockade with mavrilimumab in severe COVID-19 ' 'pneumonia and systemic hyperinflammation: a single-centre, prospective ' 'cohort study. 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The ' 'study was approved by the Medical Ethics Committee of the First Affiliated ' 'Hospital of Chongqing Medical University (K2023-066). The institutional review ' 'board of the First Affiliated Hospital of Chongqing Medical University, Jinshan ' 'Campus of the First Affiliated Hospital of Chongqing Medical University, The ' 'Seventh People’s Hospital of Chongqing, People’s Hospital of Shapingba ' 'District, Affiliated University Town Hospital of Chongqing Medical University ' 'and Chongqing University Three Gorges Hospital approved the analysis of ' 'patients’ clinical and radiological data. Because of the retrospective nature ' 'of the study, the requirement for informed consent was waived by the Medical ' 'Ethics Committee of the First Affiliated Hospital of Chongqing Medical ' 'University. The data were de-identified and only then transferred for analysis.', 'order': 2, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Ethics approval and consent to participate'}}, { 'value': 'All authors have accepted responsibility for the entire content of this ' 'manuscript and approved its submission.', 'order': 3, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Consent for publication'}}, { 'value': 'The authors declare no competing interests.', 'order': 4, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '24317'}
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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