Determinants of the protective effect of glucocorticoids on mortality in hospitalized patients with COVID-19: Insights from the Cardio-COVID-Italy multicenter study. (July 2021)

• Record Type: Journal Article
• Authors: Pagnesi, Matteo; Inciardi, Riccardo M.; Lombardi, Carlo M.; Agostoni, Piergiuseppe; Ameri, Pietro; Barbieri, Lucia; Bellasi, Antonio; Camporotondo, Rita; Canale, Claudia; Carubelli, Valentina; Carugo, Stefano; Catagnano, Francesco; Dalla Vecchia, Laura A.; Danzi, Gian Battista; Di Pasquale, Mattia; Gaudenzi, Margherita; Giovinazzo, Stefano; Gnecchi, Massimiliano; Guazzi, Marco; Iorio, Annamaria; La Rovere, Maria Teresa; Leonardi, Sergio; Maccagni, Gloria; Mapelli, Massimo; Margonato, Davide; Merlo, Marco; Monzo, Luca; Mortara, Andrea; Nuzzi, Vincenzo; Piepoli, Massimo; Porto, Italo; Pozzi, Andrea; Sarullo, Filippo; Sinagra, Gianfranco; Tedino, Chiara; Tomasoni, Daniela; Volterrani, Maurizio; Zaccone, Gregorio; Senni, Michele; Metra, Marco;
• Is Part Of: International journal of infectious diseases. Volume 108(2021)
• Page Start: 270
• Page End: 273
• Publication Date: 2021-07
• Subjects: COVID-19 -- SARS-CoV-2 -- Glucocorticoid -- Corticosteroid -- Steroid; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2021.05.056
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Glucocorticoids are an effective therapy for patients hospitalized with COVID-19. The use of glucocorticoids was associated with a lower risk of in-hospital mortality. A protective effect was mainly observed in patients with worse respiratory parameters. Abstract: Background: Glucocorticoid therapy has emerged as an effective therapeutic option in hospitalized patients with coronavirus disease 2019 (COVID-19). This study aimed to focus on the impact of relevant clinical and laboratory factors on the protective effect of glucocorticoids on mortality. Methods: A sub-analysis was performed of the multicenter Cardio-COVID-Italy registry, enrolling consecutive patients with COVID-19 admitted to 13 Italian cardiology units between 01 March 2020 and 09 April 2020. The primary endpoint was in-hospital mortality. Results: A total of 706 COVID-19 patients were included (349 treated with glucocorticoids, 357 not treated with glucocorticoids). After adjustment for relevant covariates, use of glucocorticoids was associated with a lower risk of in-hospital mortality (adjusted HR 0.44; 95% CI 0.26–0.72; p = 0.001). A significant interaction was observed between the protective effect of glucocorticoids on mortality and PaO2 /FiO2 ratio on admission (p = 0.042), oxygen saturation on admission (p = 0.017), and peak CRP (0.023). Such protective effects of glucocorticoids were mainly observed in patients with lower PaO2 /FiO2 ratio (<300), lower oxygen saturation (<90%), and higher CRP (>100 mg/L). Conclusions: The protective effects of glucocorticoids on mortality in COVID-19 were more evident among patients with worse respiratory parameters and higher systemic inflammation.