Objectives Evaluate the impact on 30-day mortality of early use of corticosteroids in patients with COVID-19 with supplementary oxygen requirements and without invasive mechanical ventilation at the initiation of therapy. Methods Between April 15 th and July 15 th , 2020, all hospitalized patients with COVID-19 and oxygen requirements were prospectively included in a database. Patients who died or required intubation within the first 48 hours were excluded. Patients who received corticoids within the first 5 days of hospitalization and at least 24 hours prior to intubation were considered as in “early corticosteroids group.” To compare both populations and adjust for non-random treatment assignment bias a weight adjusted propensity score model was used. Results 571 patients met the inclusion criteria, 520 had sufficient information for the analysis. Of these, 233 received early corticosteroids and 287 did not. After the analysis, a reduction of 8.5% (p = 0.038) in 30 -day mortality was observed in the early corticosteroid group. The reduction in mortality was nonsignificant when patients with corticosteroid initiation between day 5 and day 8 of hospitalization were included. Conclusion Early corticosteroid use in patients with pneumonia due to COVID-19 and supplementary oxygen requirements without invasive mechanical ventilation reduces mortality.
Coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus discovered in December 2019 in Wuhan, China, has had an enormous impact on public health worldwide due to its rapid spread and pandemic behavior, challenges in its control and mitigation, and few therapeutic alternatives. In this review, we summarize the pathophysiological mechanisms, clinical presentation, and diagnostic techniques. In addition, the main lineages and the different strategies for disease prevention are reviewed, with emphasis on the development of vaccines and their different platforms. Finally, some of the currently available therapeutic strategies are summarized. Throughout the article, we point out the current knowns and unknowns at the time of writing this article.
IntroductionThe COmmunity Cohort Study aims to determine, after natural exposure to SARS-CoV-2 or anti-SARS-CoV-2 vaccines deployed in Chile to prevent COVID-19 in the context of the current pandemic, the strength and duration of detectable neutralising antibodies in adult ambulatory primary care patients with cardiovascular risk factors.Methods and analysisWe will set up a community-based longitudinal, prospective cohort study. The study will be conducted in two public outpatient clinics located in the southern district of Santiago, Chile. We expect to begin recruitment in the second quarter of 2022. Each patient will be followed up for at least 1 year after inclusion in the cohort. The eligible population will be adult patients registered in the Cardiovascular Health Programme. Exposure in this study is defined as any event where participants have contact with SARS-CoV-2 antigens from natural exposure or vaccination. The primary outcomes are seroconversion and strength and duration of the neutralising IgG antibodies to SARS-CoV-2. Secondary outcomes are any COVID-19-related event or intercurrent morbidities or death. Data will be collected by extracting serial blood samples and administering a questionnaire at the first face-to-face contact and monthly follow-up time points. The sample size estimated for this study is 1060. We will characterise the cohort, determine the seroprevalence rate of neutralising antibodies at baseline and determine the rates of antibody decline using a longitudinal mixed-effects model.Ethics and disseminationThe Scientific Ethics Committee of the South Metropolitan Health Care Service approved the study protocol (Memorandum No 191/2021). We will present the results in two peer-reviewed publications and national and international professional and academic meetings. We will organise seminars with relevant stakeholders and hold town hall meetings with the local community. We will set up a COmmunity Cohort Study website at www.communitystudy.cl to disseminate the study purpose, research team and milestones.
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