Corticosteroid Therapy Is Associated With Improved Outcome in Critically Ill Patients With COVID-19 With Hyperinflammatory Phenotype

Chen, Hui; Xie, Jianfeng; Su, Nan; Wang, Jun; Sun, Qiang; Li, Shusheng; Jin, Jun; Zhou, Jing; Mo, Min; Yao, Wei; Chao, Yali; Hu, Weiwei; Du, Bin; Qiu, Haibo

doi:10.1016/j.chest.2020.11.050

Cited by 61 publications

(72 citation statements)

References 30 publications

(22 reference statements)

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“… 18 As anti-inflammation agents, glucocorticoids have been used to treat COVID-19 patients with hyper-inflammatory phenotype. 19 , 20 , 21 , 22 Increased blood triglyceride is a side effect associated with glucocorticoid treatment. 23 , 24 , 25 In order to investigate whether glucocorticoid treatment affected the association between hypertriglyceridemia and mortality in our study, we collected information on glucocorticoid treatment during hospitalization period, including the use of betamethasone, dexamethasone, hydrocortisone, methylprednisolone, prednisone and budesonide.…”

Section: Resultsmentioning

confidence: 99%

Hypertriglyceridemia during hospitalization independently associates with mortality in patients with COVID-19

Dai

Lund

Chen

et al. 2021

Journal of Clinical Lipidology

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This study was funded by a COVID-19 Rapid Response Grant to ZZ from the Medical College of Wisconsin Cardiovascular Center through the Cullen Run Foundation, a startup fund to ZZ from the Medical College of Wisconsin and Blood Research Institute through the Advancing a Healthier Wisconsin Endowment, a Fellow Scholar Award to ZZ from the American Society of Hematology, and a Career Development Award (19CDA34660043) to ZZ from the American Heart Association. The Medical College of Wisconsin Clinical Research Data Warehouse was supported by the NIH National Center for Advancing Translational Sciences (to Clinical & Translational Science Institute of Southeast Wisconsin, UL1TR001436). Background. Alteration in blood triglyceride levels have been found in patients with coronavirus disease 2019 (COVID-19). However, the association between hypertriglyceridemia and mortality in COVID-19 patients is unknown. Objective. To investigate the association between alteration in triglyceride level and mortality in hospitalized COVID-19 patients. Methods. We conducted a retrospective study of 600 hospitalized patients with COVID-19 diagnosis (ICD10CM:U07.1) and/or SARS-CoV-2 positive testing results between March 1, 2020 and December 21, 2020 at a tertiary academic medical center in Milwaukee, Wisconsin. De-identified data, including demographics, medical history, and blood triglyceride levels were collected and analyzed. Of the 600 patients, 109 patients died. The triglyceride value on admission was considered the baseline and the peak was defined as the highest level reported during the entire period of hospitalization. Hypertriglyceridemia was defined as greater than 150 mg/dl. Logistic regression analyses were performed to evaluate the association between hypertriglyceridemia and mortality. Results. There was no significant difference in baseline triglyceride levels between non-survivors (n=109) and survivors (n=491) [Median 127 vs. 113 mg/dl, p =0.213]. However, the non-survivors had significantly higher peak triglyceride levels during hospitalization [Median 179 vs. 134 mg/dl, p <0.001]. Importantly, hypertriglyceridemia independently associated with mortality [odds ratio=2.3 (95% CI: 1.4-3.7, p =0.001)], after adjusting for age, gender, obesity, history of hypertension and diabetes, high CRP, high leukocyte count and glucocorticoid treatment in a multivariable logistic regression model. Conclusions. Hypertriglyceridemia during hospitalization is independently associated with 2.3 times higher mortality in COVID-19 patients. Prospective studies are needed to independently validate this retrospective analysis.

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Section: Resultsmentioning

confidence: 99%

Hypertriglyceridemia during hospitalization independently associates with mortality in patients with COVID-19

Dai

Lund

Chen

et al. 2021

Journal of Clinical Lipidology

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“…Moreover, compared to the patients with 1 extrapulmonary organ injury, a much higher level of IL-6 and much lower lymphocyte count were observed in patients with more than one extrapulmonary organ injury. Recent study indicated that the use of corticosteroids showed significant survival benefits in patients with the hyperinflammatory phenotype (25). Hence, detecting and monitoring the level of inflammatory cytokines, such as IL-6, and lymphocyte count may help clinicians to focus on extrapulmonary organ function to exclude ARDS so as to identify severe COVID patients and provide better treatment.…”

Section: Discussionmentioning

confidence: 99%

Early risk factors for extrapulmonary organ injury in adult COVID-19 patients

Huang¹,

Ma²,

Zheng³

et al. 2021

Ann Transl Med

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Background: The novel 2019 coronavirus has caused a global pandemic, and often leads to extrapulmonary organ injury. However, the risk factors for extrapulmonary organ injury are still unclear. We aim to explore the risk factors for extrapulmonary organ injury and the association between extrapulmonary organ injury and the prognosis in COVID-19 patients. Methods:We implemented a single-center, retrospective, observational study, in which a total of 349 confirmed COVID-19 patients admitted to Tongji Hospital from January 25, 2020, to February 25, 2020, were enrolled. We collected demographic, clinical, laboratory, and treatment data from electronic medical records. Potential risk factors for extrapulmonary organ injury of COVID-19 patients were analyzed by a multivariable binary logistic model, and multivariable Cox proportional hazards regression model was used for survival analysis in the patients with extrapulmonary organ injury. Results:The average age of the included patients was 61.73±14.64 years. In the final logistic model, variables including aged 60 or older [odds ratio (OR) 1.826, 95% confidence interval (CI): 1.060-3.142], acute respiratory distress syndrome (ARDS) (OR 2.748, 95% CI: 1.051-7.185), lymphocytes count lower than 1.1×10 9 /L (OR 0.478, 95% CI: 0.240-0.949), level of interleukin-6 (IL-6) greater than 7 pg/mL (OR 1.664, 95% CI: 1.005-2.751) and D-Dimer greater than 0.5 μg/mL (OR 2.190, 95% CI: 1.176-4.084) were significantly associated with the extrapulmonary organ injury. Kaplan-Meier curve and log-rank test showed that the probabilities of survival for patients with extrapulmonary organ injury were significantly lower than those without extrapulmonary organ injury. Multivariate Cox proportional hazards model showed that only myocardial injury (P=0.000, HR: 5.068, 95% CI: 2.728-9.417) and circulatory system injury (P=0.000, HR: 4.076, 95% CI: 2.216-7.498) were the independent factors associated with COVID-19 patients' poor prognosis. Conclusions: Older age, lymphocytopenia, high level of D-Dimer and IL-6, and the severity of lung injury were the high-risk factors of extrapulmonary organ injury in COVID-19 patients. Myocardial and circulatory system injury were the most important risk factors related to poor outcomes of COVID-19 patients. It may

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“…The RECOVERY study showed that glucocorticoids could reduce mortality in patients with severe COVID-19 [ 9 ]. Approximately half of the patients received glucocorticoids in Wuhan; however, we found that glucocorticoid treatment was not associated with better outcomes in a cohort study [ 10 ]. We used an unsupervised machine learning approach to identify inflammatory phenotypes and found that glucocorticoids were associated with lower mortality in patients with a highly inflammatory phenotype [ 10 ].…”

Section: Clinical Managementmentioning

confidence: 99%