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

• Published in: PloS one Vol. 17; no. 1; p. e0261711
• Main Authors: Lavilla Olleros, Cristina, Ausín García, Cristina, Bendala Estrada, Alejandro David, Muñoz, Ana, Wikman Jogersen, Philip Erick, Fernández Cruz, Ana, Giner Galvañ, Vicente, Vargas, Juan Antonio, Seguí Ripoll, José Miguel, Rubio-Rivas, Manuel, Miranda Godoy, Rodrigo, Mérida Rodrigo, Luis, Fonseca Aizpuru, Eva, Arnalich Fernández, Francisco, Artero, Arturo, Loureiro Amigo, Jose, García García, Gema María, Corral Gudino, Luis, Jiménez Torres, Jose, Casas-Rojo, José-Manuel, Millán Núñez-Cortés, Jesús
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 21.01.2022; Public Library of Science (PLoS)
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Age Factors; Aged; Aged, 80 and over; Analysis; Biology and Life Sciences; Complications; Coronaviruses; Corticoids; Corticosteroids; COVID-19; COVID-19 - drug therapy; COVID-19 - epidemiology; COVID-19 - mortality; COVID-19 - virology; Demographics; Dosage and administration; Drug Administration Schedule; Drug dosages; Epidemiology; Female; Funding; Glucocorticoids; Hospital Mortality - trends; Hospitals; Humans; Inflammation; Internal medicine; Laboratories; Male; Medical records; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Patients; Pneumonia; Prednisone - therapeutic use; Registries; SARS-CoV-2 - growth & development; SARS-CoV-2 - pathogenicity; Sepsis; Sepsis - drug therapy; Sepsis - epidemiology; Sepsis - mortality; Sepsis - virology; Severe acute respiratory syndrome coronavirus 2; Software; Spain - epidemiology; Steroids; Survival Analysis; Therapy; Treatment Outcome; Variance analysis; Spain; Madrid Spain
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0261711

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. 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. 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]; p < .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 < .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 < .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 < .001 and OR 0.80 95% CI 0.65-0.97; p < .001) respectively. There is no difference in mortality with megadoses versus low-dose, but there is a lower incidence of infectious complications with glucocorticoid megadoses.