Effects of Pulse Dose of Corticosteroids in Hospitalized Patients with COVID-19: An Observational Study
Abstract
Background: Although corticosteroids are commonly used for COVID-19 disease during the inflammatory phase, the effective doses and the best choice of corticosteroids are not yet known. Methods: In the present study, the effects of non-pulse (30-250 mg/day of prednisolone equivalent) versus pulse equivalent (>250 mg/day of prednisolone equivalent) doses of corticosteroids are compared in terms of the patients’ oxygen saturation, hospital mortality, and side effects. In addition, the patients were followed for 2 months for readmission and mortality. Results: 270 severe or critically ill patients with COVID-19 disease were included in the study. Diabetes and hypertension were the most common comorbidities. More than 80% of the patients received corticosteroids. Pulse equivalent doses of corticosteroids were used in 36.9 % of the patients. Treatment with pulse doses of corticosteroid significantly increased the oxygen saturation in the critically ill patients. However, the pulse doses significantly increased the in-hospital mortality rate [29 (20.3%) vs. 12 (10.6%), p=0.036] and the side effects. In addition, a trend toward higher 60-day mortality was observed in the pulse-based-treated patients [31 (21.7%) vs. 14 (12.4%), p=0.053]. The multivariate analysis showed that having comorbidities increased the mortality risk independently [OR 3.33, CI 1.148-9.647]. Conclusion: The results showed that the pulse doses of corticosteroids increase the oxygen saturation, but they also can increase mortality. Further randomized controlled trials with larger sample sizes are needed to confirm our findings.
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25. Edalatifard M, Akhtari M, Salehi M, et al. Intravenous methylprednisolone pulse as a treatment for hospitalised severe COVID-19 patients: results from a randomised controlled clinical trial. Eur Respir J 2020;56(6):2002808..
26. Pinzón MA, Ortiz S, Holguín H, et al. Dexamethasone vs. methylprednisolone high dose for Covid-19 pneumonia. PLoS One 2021;16(5): e0252057.
27. Monreal E, de la Maza SS, Natera-Villalba E, et al. High versus standard doses of corticosteroids in severe COVID-19: a retrospective cohort study. Eur J Clin Microbiol Infect Dis 2021;40(4):761-9.
28. Kumar G, Patel D, Hererra M, et al. Do high‐dose corticosteroids improve outcomes in hospitalized COVID‐19 patients? Journal of Medical Virology 2022;94(1):372-9.
29. Wilson JG, Simpson LJ, Ferreira AM, et al. Cytokine profile in plasma of severe COVID-19 does not differ from ARDS and sepsis. JCI Insight 2020;5(17):e140289.
30. Koehler P, Bassetti M, Chakrabarti A, et al. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis 2021;21(6): e149-e62.
31. Eslami G, Mousaviasl S, Radmanesh E, et al. The impact of sofosbuvir/daclatasvir or ribavirin in patients with severe COVID-19. J Antimicrob Chemother 2020;75(11):3366-72.
32. Sadeghi A, Ali Asgari A, Norouzi A, et al. Sofosbuvir and daclatasvir compared with standard of care in the treatment of patients admitted to hospital with moderate or severe coronavirus infection (COVID-19): a randomized controlled trial. J Antimicrob Chemother 2020;75(11):3379-85.
33. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med 2020;383(19):1813-26.
34. Beović B, Doušak M, Ferreira-Coimbra J, et al. Antibiotic use in patients with COVID-19: a 'snapshot' Infectious Diseases International Research Initiative (ID-IRI) survey. J Antimicrob Chemother 2020;75(11):3386-90.
35. Seaton RA, Gibbons CL, Cooper L, et al. Survey of antibiotic and antifungal prescribing in patients with suspected and confirmed COVID-19 in Scottish hospitals. J Infect 2020;81(6):952-60.
36. Razazi K, Arrestier R, Haudebourg AF, Botterel F, Mekontso Dessap A. Pneumocystis pneumonia risk among viral acute respiratory distress syndrome related or not to COVID 19. Crit Care 2021;25(1):1-4.
2. Meyerowitz-Katz G, Merone L. A systematic review and meta-analysis of published research data on COVID-19 infection fatality rates. Int J Infect Dis 2020; 101:138-48.
3. Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: A clinical-therapeutic staging proposal. J Heart Lung 2020;39(5):405-7.
4. Del Valle DM, Kim-Schulze S, Huang HH, et al. An inflammatory cytokine signature predicts COVID-19 severity and survival. Nat Med 2020;26(10):1636-43.
5. Leisman DE, Ronner L, Pinotti R, et al. Cytokine elevation in severe and critical COVID-19: a rapid systematic review, meta-analysis, and comparison with other inflammatory syndromes. Lancet Respir Med 2020;8(12):1233-44.
6. Attaway AH, Scheraga RG, Bhimraj A, Biehl M, Hatipoğlu U. Severe covid-19 pneumonia: pathogenesis and clinical management. BMJ 2021;372: n436.
7. COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/. Accessed [cited 2022, January 14].
8. Malas MB, Naazie IN, Elsayed N, Mathlouthi A, Marmor R, Clary B. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis. E Clinical Medicine 2020; 29:100639.
9. Chi G, Lee JJ, Jamil A, et al. Venous Thromboembolism among Hospitalized Patients with COVID-19 Undergoing Thromboprophylaxis: A Systematic Review and Meta-Analysis. J Clin Med 2020;9(8): 2489.
10. Rochwerg B, Siemieniuk RA, Agoritsas T, et al. A living WHO guideline on drugs for covid-19. BMJ 2020;370:m3379.
11. Ahmed MH, Hassan A. Dexamethasone for the Treatment of Coronavirus Disease (COVID-19): a Review. SN Compr Clin Med 2020:1-10.
12. RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med 2021;384(8):693-704.
13. Chaudhuri D, Sasaki K, Karkar A, et al. Corticosteroids in COVID-19 and non-COVID-19 ARDS: a systematic review and meta-analysis. Intensive Care Med 2021;47(5):521-37.
14. Ye Z, Wang Y, Colunga-Lozano LE, et al. Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis. CMAJ 2020;192(27):E756-E767.
15. Johns M, George S, Taburyanskaya M, Poon YK. A Review of the Evidence for Corticosteroids in COVID-19. J Pharm Pract 2021:897190021998502.
16. van Paassen J, Vos JS, Hoekstra EM, Neumann KMI, Boot PC, Arbous SM. Corticosteroid use in COVID-19 patients: a systematic review and meta-analysis on clinical outcomes. Crit Care 2020;24(1):696.
17. Cusacovich I, Aparisi a, Marcos M, et al. Corticosteroid Pulses for Hospitalized Patients with COVID-19: Effects on Mortality. Mediators Inflamm 2021; 2021:6637227.
18. López Zúñiga MÁ, Moreno-Moral A, Ocaña-Granados A, et al. High-dose corticosteroid pulse therapy increases the survival rate in COVID-19 patients at risk of hyper-inflammatory response. PLoS One 2021;16(1): e0243964-e.
19. Tamura K, Nishioka S, Tamura N, Saito Z, Kuwano K. Successful treatment with methyl-prednisolone pulses for the late phase of COVID-19 with respiratory failure: A single-center case series. Respir Med Case Rep 2020; 31:101318.
20. Buttgereit F, Da Silva JA, Boers M, et al. Standardized nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology. Ann Rheum Dis 2002;61(8):718-22.
21. Rochwerg B, Agarwal A, Siemieniuk RA, et al. A living WHO guideline on drugs for covid-19. BMJ 2020;370:m3379.
22. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clinical Practice 2012;120(4):c179-84.
23. Health UDo, Services H. National Institute of Allergy and Infectious Diseases, Division of AIDS. Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 2.0.[November 2014]. 2017.
24. Tomazini BM, Maia IS, Cavalcanti AB, et al. Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized Clinical Trial. JAMA 2020;324(13):1307-16.
25. Edalatifard M, Akhtari M, Salehi M, et al. Intravenous methylprednisolone pulse as a treatment for hospitalised severe COVID-19 patients: results from a randomised controlled clinical trial. Eur Respir J 2020;56(6):2002808..
26. Pinzón MA, Ortiz S, Holguín H, et al. Dexamethasone vs. methylprednisolone high dose for Covid-19 pneumonia. PLoS One 2021;16(5): e0252057.
27. Monreal E, de la Maza SS, Natera-Villalba E, et al. High versus standard doses of corticosteroids in severe COVID-19: a retrospective cohort study. Eur J Clin Microbiol Infect Dis 2021;40(4):761-9.
28. Kumar G, Patel D, Hererra M, et al. Do high‐dose corticosteroids improve outcomes in hospitalized COVID‐19 patients? Journal of Medical Virology 2022;94(1):372-9.
29. Wilson JG, Simpson LJ, Ferreira AM, et al. Cytokine profile in plasma of severe COVID-19 does not differ from ARDS and sepsis. JCI Insight 2020;5(17):e140289.
30. Koehler P, Bassetti M, Chakrabarti A, et al. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis 2021;21(6): e149-e62.
31. Eslami G, Mousaviasl S, Radmanesh E, et al. The impact of sofosbuvir/daclatasvir or ribavirin in patients with severe COVID-19. J Antimicrob Chemother 2020;75(11):3366-72.
32. Sadeghi A, Ali Asgari A, Norouzi A, et al. Sofosbuvir and daclatasvir compared with standard of care in the treatment of patients admitted to hospital with moderate or severe coronavirus infection (COVID-19): a randomized controlled trial. J Antimicrob Chemother 2020;75(11):3379-85.
33. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med 2020;383(19):1813-26.
34. Beović B, Doušak M, Ferreira-Coimbra J, et al. Antibiotic use in patients with COVID-19: a 'snapshot' Infectious Diseases International Research Initiative (ID-IRI) survey. J Antimicrob Chemother 2020;75(11):3386-90.
35. Seaton RA, Gibbons CL, Cooper L, et al. Survey of antibiotic and antifungal prescribing in patients with suspected and confirmed COVID-19 in Scottish hospitals. J Infect 2020;81(6):952-60.
36. Razazi K, Arrestier R, Haudebourg AF, Botterel F, Mekontso Dessap A. Pneumocystis pneumonia risk among viral acute respiratory distress syndrome related or not to COVID 19. Crit Care 2021;25(1):1-4.
| Files | ||
| Issue | Vol 10, No 1 (Winter 2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jpc.v10i1.9125 | |
| Keywords | ||
| Drug Therapeutic Index Corticosteroids COVID-19 | ||
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How to Cite
1.
Nikpour H, Heydarpour F, Zamanian MH, Vaziri S, Shahbazi F. Effects of Pulse Dose of Corticosteroids in Hospitalized Patients with COVID-19: An Observational Study. J Pharm Care. 2022;10(1):22-27.
