Early Short Course Corticosteroids in Hospitalized Patients with COVID-19

Early Short Course Corticosteroids in Hospitalized Patients with COVID-19

Publication date: May 04, 2020

Background: There is no proven antiviral or immunomodulatory therapy for COVID-19. The disease progression associated with the pro-inflammatory host response prompted us to examine the role of early corticosteroid therapy in patients with moderate to severe COVID-19. Methods: We conducted a single pre-test, single post-test quasi-experiment in a multi-center health system in Michigan from March 12 to March 27, 2020. Adult patients with confirmed moderate to severe COVID were included. A protocol was implemented on March 20, 2020 using early, short-course, methylprednisolone 0.5 to 1 mg/kg/day divided in 2 intravenous doses for 3 days. Outcomes of pre- and post-corticosteroid groups were evaluated. A composite endpoint of escalation of care from ward to ICU, new requirement for mechanical ventilation, and mortality was the primary outcome measure. All patients had at least 14 days of follow-up. Results: We analyzed 213 eligible subjects, 81 (38%) and 132 (62%) in pre-and post-corticosteroid groups, respectively. The composite endpoint occurred at a significantly lower rate in post-corticosteroid group compared to pre-corticosteroid group (34.9% vs. 54.3%, p=0.005). This treatment effect was observed within each individual component of the composite endpoint. Significant reduction in median hospital length of stay was observed in the post-corticosteroid group (8 vs. 5 days, p PDF

Concepts Keywords
Antibiotic Medicine
Antiviral Medical specialties
AOR Viral therapy
ARDS Mechanical ventilation
Assay Cannula
Austin Adjunctive therapy
Chain Reaction Baseline illness
Chest Radiography Bilateral pulmonary infiltrates
China Pro inflammatory host
Clinical Microbiology Inflammatory cytokine storm
Comorbidities Immunopathological lung injury
Composite Endpoint Severity illness
Computed Tomography Influenza infection
Coronavirus Institutional protocol
Corticosteroid Health
Corticosteroids Intensive care medicine
Cytokine Storm Corticosteroid
Detroit Cytokine release syndrome
Dyspnea Methylprednisolone
Emergency Room Mechanical ventilation
Epidemic Intensive care unit
Ford System 16 Corticosteroid Protocol
Henry Ford Tomography
Henry Ford Hospital
Hfhs
HFHS
Hospital
Hydroxychloroquine
Hypoxia
Immunology
Immunomodulatory
Infection
Influenza
Intensive Care Unit
Intravenous
Lung
Mechanical Ventilation
Mechanically Ventilated
Methylprednisolone
Michigan
Mortality
Nasal Cannula
Nasopharyngeal
Oxygen
Pallavi
Pathogenic
Pathophysiology
PCR
Phylogenetically
Physician
Prednisone
Protocol
Pulmonary
Radiographic
Regression
Respiratory Failure
Ribavirin
Ritonavir
SARS
Supportive Care
Symptom
Vasopressor
Viral
Vital Signs
Ward
West Grand Boulevard
Wuhan

Semantics

Type Source Name
disease MESH disease progression
drug DRUGBANK Methylprednisolone
disease MESH Infectious Diseases
disease MESH lung injury
disease MESH acute respiratory distress syndrome
disease MESH death
drug DRUGBANK Oxygen
disease MESH coronavirus infections
disease MESH infection
disease MESH hypoxia
disease MESH respiratory failure
disease MESH renal
drug DRUGBANK Lopinavir
drug DRUGBANK Ritonavir
drug DRUGBANK Ribavirin
drug DRUGBANK Hydroxychloroquine
drug DRUGBANK Tocilizumab
drug DRUGBANK Prednisone
disease MESH Emergency
disease MESH shock
disease MESH acute kidney injury
disease MESH Kidney Disease

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