Cumulative steroid dose in hospitalized patients and COVID-19-associated pulmonary aspergillosis

Ramonfaur, Diego; Salto-Quintana, Jack N.; Aguirre-García, Gloria Mayela; Hernández-Mata, Nadia M.; Villanueva-Lozano, Hiram; Torre‐Amione, Guillermo; Martínez‐Reséndez, Michel F.

doi:10.1016/j.jhin.2023.07.009

Cited by 2 publications

(1 citation statement)

References 22 publications

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“…During the treatment of infection, the use of corticosteroids is not recommended as it may aggravate the condition. 18 , 19 , 20 However, corticosteroids are the most frequently administrated treatment for DPLD. 8 Ensuring that DPLD patients are in a non-infected state is essential prior to subsequent corticosteroids therapy.…”

Section: Discussionmentioning

confidence: 99%

Optimizing treatment administration strategies using negative mNGS results in corticosteroid-sensitive diffuse parenchymal lung diseases

Jing,

Ding,

Zhou

et al. 2024

iScience

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Section: Discussionmentioning

confidence: 99%

Optimizing treatment administration strategies using negative mNGS results in corticosteroid-sensitive diffuse parenchymal lung diseases

Jing,

Ding,

Zhou

et al. 2024

iScience

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High-Dose Corticosteroid Use in Severe to Critically Ill Patients With COVID-19: A Nationwide Population-Based Matched Cohort Study

Lee,

Cho,

Lee

et al. 2024

J Korean Med Sci

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Background Systemic corticosteroids have become the standard of care for severe to critically ill patients with coronavirus disease 2019 (COVID-19). However, the real-world efficacy and safety outcomes associated with a higher dose of corticosteroids remain uncertain. Methods We conducted a nationwide, population-based, matched cohort study of severe to critically ill adult patients with COVID-19 between January 2020 and June 2021 in Korea using the National Health Information Database. Patients using systemic corticosteroids were included and high-dose corticosteroid use was defined as a daily mean prescribed dose of more than 6 mg of dexamethasone. We then employed a proportional hazard regression model to identify prognostic factors for 28-day all-cause mortality and conducted a Fine and Gray regression model to assess risk factors for developing COVID-19-associated pulmonary aspergillosis (CAPA). Results During the study period, 102,304 patients with COVID-19 were screened, 5,754 met the eligibility criteria, and 2,138 were successfully matched. The mean prescribed daily dose was 4.2 mg and 13.4 mg in the standard- and high-dose groups, respectively, and the mean duration of use was not different between the groups. High-dose corticosteroid use independently increased all-cause mortality at 28 days (adjusted hazard ratio [aHR], 1.48; 95% confidence interval [CI], 1.25–1.76) and 90 days (aHR, 1.63; CI, 1.44–1.85) after admission. Subgroup analysis revealed a statistically significant elevation in the risk of mortality among patients using low-flow or high-flow nasal cannulas, with aHRs of 1.41 and 1.46, respectively. No significant impact of high-dose steroids was observed, even in patients who underwent mechanical ventilation at 28 days (aHR, 1.17; CI, 0.79–1.72). As a safety outcome, high-dose corticosteroid use showed an association with the development of CAPA (aHR, 2.97; 95% CI, 0.94–9.43). Conclusion Among severe to critically ill patients with COVID-19, high-dose corticosteroid use was associated with increased 28-day all-cause mortality and showed a trend toward the development of CAPA.

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Cumulative steroid dose in hospitalized patients and COVID-19-associated pulmonary aspergillosis

Cited by 2 publications

References 22 publications

Optimizing treatment administration strategies using negative mNGS results in corticosteroid-sensitive diffuse parenchymal lung diseases

Optimizing treatment administration strategies using negative mNGS results in corticosteroid-sensitive diffuse parenchymal lung diseases

High-Dose Corticosteroid Use in Severe to Critically Ill Patients With COVID-19: A Nationwide Population-Based Matched Cohort Study

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