A Review of the Evidence for Corticosteroids in COVID-19

Johns, Meagan; George, Stephy; Taburyanskaya, Margarita; Poon, Yi Kee

doi:10.1177/0897190021998502

Cited by 38 publications

(39 citation statements)

References 47 publications

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“…The anti-inflammatory effects of corticosteroids are proven by inducing the synthesis of anti-inflammatory proteins and, on the other hand, by inhibiting the synthesis of proinflammatory proteins [ 32 ]. It is crucial to start corticosteroid treatment at the right time and in the right patient since early administration and administration to patients with asymptomatic and milder forms of the disease may have adverse effects [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

D-dimer, CRP, PCT, and IL-6 Levels at Admission to ICU Can Predict In-Hospital Mortality in Patients with COVID-19 Pneumonia

Milenkovic

Hadžibegović

Kovač³

et al. 2022

Oxidative Medicine and Cellular Longevity

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Introduction. Health care workers have had a challenging task since the COVID-19 outbreak. Prompt and effective predictors of clinical outcomes are crucial to recognize potentially critically ill patients and improve the management of COVID-19 patients. The aim of this study was to identify potential predictors of clinical outcomes in critically ill COVID-19 patients. Methods. The study was designed as a retrospective cohort study, which included 318 patients treated from June 2020 to January 2021 in the Intensive Care Unit (ICU) of the Clinical Hospital Center “Bezanijska Kosa” in Belgrade, Serbia. The verified diagnosis of COVID-19 disease, patients over 18 years of age, and the hospitalization in ICU were the criteria for inclusion in the study. The optimal cutoff value of D-dimer, CRP, IL-6, and PCT for predicting hospital mortality was determined using the ROC curve, while the Kaplan-Meier method and log-rank test were used to assess survival. Results. The study included 318 patients: 219 (68.9%) were male and 99 (31.1%) female. The median age of patients was 69 (60-77) years. During the treatment, 195 (61.3%) patients died, thereof 130 male (66.7%) and 65 female (33.3%). 123 (38.7%) patients were discharged from hospital treatment. The cutoff value of IL-6 for in-hospital death prediction was 74.98 pg/mL (Sn 69.7%, Sp 62.7%); cutoff value of CRP was 81 mg/L (Sn 60.7%, Sp 60%); cutoff value of procalcitonin was 0.56 ng/mL (Sn 81.1%, Sp 76%); and cutoff value of D-dimer was 760 ng/mL FEU (Sn 63.4%, Sp 57.1%). IL- 6 ≥ 74.98 pg/mL, CRP ≥ 81 mg/L, PCT ≥ 0.56 ng/mL, and D- dimer ≥ 760 ng/mL were statistically significant predictors of in-hospital mortality. Conclusion. IL- 6 ≥ 74.98 pg/mL, CRP values ≥ 81 mg/L, procalcitonin ≥ 0.56 ng/mL, and D- dimer ≥ 760 ng/mL could effectively predict in-hospital mortality in COVID-19 patients.

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Section: Discussionmentioning

confidence: 99%

D-dimer, CRP, PCT, and IL-6 Levels at Admission to ICU Can Predict In-Hospital Mortality in Patients with COVID-19 Pneumonia

Milenkovic

Hadžibegović

Kovač³

et al. 2022

Oxidative Medicine and Cellular Longevity

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“…Dexamethasone was administered orally or intravenously at a dose of 6 mg/day for up to 10 days, or until hospital discharge. Patients requiring invasive mechanical ventilation (IMV) and receiving dexamethasone had a reduced death rate than those receiving standard treatment alone (29.3% vs. 41.4%, rate ratio ¼ 0.64: CI95%: 0.51-0.81), as well as in those receiving supplemental oxygen without IMV (23.3% vs. 26.2%, rate ratio ¼ 0.82, CI 95%: 0.72-0.94) 18 . Based on these convincing results, the same dosage of dexamethasone was routinely used in our patients with severe COVID-19 in the second wave, which may also be a factor for improved management and low mortality in our treatment center.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological, clinical Characteristics and mortality of patients Infected with SARS-CoV-2 Admitted of Kinshasa University Hospital, Democratic Republic of the Congo from March 24, 2020 to January 30, 2021: Two waves, two faces?

Mandina

Makulo

Wumba

et al. 2021

Preprint

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Background The objective of our retrospective study was to establish a comparison between the first and the second waves of demographic and clinical characteristics as well as mortality and its determinants. Methods A total of 411 COVID-19 patients were enrolled in Kinshasa University Hospital and categorized into two groups according to the pandemic pattern, demographics, and disease severity. The clinical characteristics were compared according to the two waves. To describe survival from the first day of hospitalization until death, we used Kaplan Meier method. We used the Log Rank test to compare the survival curves between the two waves. The Cox regression was used to identify independent predictors of mortality. Results During the study period, 411 patients with confirmed COVID-19 were admitted to the hospital. The average age of patients in the 2nd wave was higher than in the first wave (between 34.9 and 67.9 years old vs between 58. 42.4 and 73.8 years old, p=0.026). The mean saturation was lower in the first wave than in the second. The death rate of patients in the first wave was higher than in the second wave (p=0.009). Survival was reduced in the first wave compared to the second wave. In the first wave, age over 60 years, respiratory distress, law oxygen saturation (lower than 89%) and severe stage of COVID-19 emerged as factors associated with death, while in the second wave it was mainly respiratory distress, law oxygen saturation (lower than 89%) and severe stage. The predictors of mortality present in both the first and second waves were respiratory distress and severe COVID-19 stage. Conclusion Mortality decreased in the second wave. Age no longer emerged as a factor in mortality in the second wave. Health system strengthening and outreach to those at high risk of mortality should continue to maintain and improve gains. Keywords SARS-COV-2, Democratic Republic of Congo, 2 waves

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“…9 Thus its properties make it beneficial for managing septic shock in patients with COVID-19. 10 Interestingly, methylprednisolone has been the preferred agent for corticosteroids therapy by many physicians since it achieves higher lung tissue to plasma ratios in animal models than dexamethasone, which works more efficiently for lung injury. 10 In a study by Ranjbar and colleagues 11 which was a tripleblinded randomized controlled trial that included 86 patients hospitalized with COVID-19.…”

Section: Pharmacokinetics and Pharmacodynamics Of Corticosteroidsmentioning

confidence: 99%

Calming the Storm: A review of corticosteroid use in severely ill COVID-19 patients on mechanical ventilation

Dinh¹,

Chu²

2021

JMV

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The importance of corticosteroids in the therapy of COVID-19 has been controversial. However, as the world develops a better understanding regarding the pathophysiology of COVID-19, we are realizing that suppressing the host immune response may reduce lung inflammation preventing further complications. In addition, more high-quality randomized controlled trials, meta-analysis, and review articles are being published discussing the role of corticosteroids. Majority of these studies concluded that corticosteroids are beneficial for hospitalized severely ill COVID-19 patients requiring supplemental oxygen. To date, therapeutic guidelines for COVID-19 patients recommend dexamethasone or other alternative corticosteroids, including methylprednisolone, hydrocortisone, or prednisone, as a treatment choice for severely ill COVID-19 patients. This review will discuss the pharmacology, mechanism of action, pharmacodynamics, pharmacokinetics, and benefits of corticosteroids in COVID-19 patients, and review current published clinical evidence on corticosteroids. Keywords: Corticosteroids, COVID-19, ARDS

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A Review of the Evidence for Corticosteroids in COVID-19

Cited by 38 publications

References 47 publications

D-dimer, CRP, PCT, and IL-6 Levels at Admission to ICU Can Predict In-Hospital Mortality in Patients with COVID-19 Pneumonia

D-dimer, CRP, PCT, and IL-6 Levels at Admission to ICU Can Predict In-Hospital Mortality in Patients with COVID-19 Pneumonia

Epidemiological, clinical Characteristics and mortality of patients Infected with SARS-CoV-2 Admitted of Kinshasa University Hospital, Democratic Republic of the Congo from March 24, 2020 to January 30, 2021: Two waves, two faces?

Calming the Storm: A review of corticosteroid use in severely ill COVID-19 patients on mechanical ventilation

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