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: Cristina Lavilla Olleros, Cristina Ausín García, Alejandro David Bendala Estrada, Ana Muñoz, Philip Erick Wikman Jogersen, Ana Fernández Cruz, Vicente Giner Galvañ, Juan Antonio Vargas, José Miguel Seguí Ripoll, Manuel Rubio-Rivas, Rodrigo Miranda Godoy, Luis Mérida Rodrigo, Eva Fonseca Aizpuru, Francisco Arnalich Fernández, Arturo Artero, Jose Loureiro Amigo, Gema María García García, Luis Corral Gudino, Jose Jiménez Torres, José-Manuel Casas-Rojo, Jesús Millán Núñez-Cortés, SEMI-COVID-19 Network
• Format: Journal Article
• Language: English
• Published: Public Library of Science (PLoS) 01.01.2022
• ISSN: 1932-6203
• DOI: 10.1371/journal.pone.0261711

ObjectiveTo 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.MethodsObservational 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.ResultsOf 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.ConclusionThere is no difference in mortality with megadoses versus low-dose, but there is a lower incidence of infectious complications with glucocorticoid megadoses.