Evolution of the Use of Corticosteroids for the Treatment of Hospitalised COVID-19 Patients in Spain between March and November 2020: SEMI-COVID National Registry

Abstract

Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence of new recommendations. Material and methods: A retrospective, descriptive, and observational study was conducted on adults hospitalised due to COVID-19 in Spain who were included in the SEMI-COVID-19 Registry from March to November 2020. Results: CTs were used in 6053 (36.21%) of the included patients. The patients were older (mean (SD)) (69.6 (14.6) vs. 66.0 (16.8) years; p < 0.001), with hypertension (57.0% vs. 47.7%; p < 0.001), obesity (26.4% vs. 19.3%; p < 0.0001), and multimorbidity prevalence (20.6% vs. 16.1%; p < 0.001). These patients had higher values (mean (95% CI)) of C-reactive protein (CRP) (86 (32.7–160) vs. 49.3 (16–109) mg/dL; p < 0.001), ferritin (791 (393–1534) vs. 470 (236–996) µg/dL; p < 0.001), D dimer (750 (430–1400) vs. 617 (345–1180) µg/dL; p < 0.001), and lower Sp02/Fi02 (266 (91.1) vs. 301 (101); p < 0.001). Since June 2020, there was an increment in the use of CTs (March vs. September; p < 0.001). Overall, 20% did not receive steroids, and 40% received less than 200 mg accumulated prednisone equivalent dose (APED). Severe patients are treated with higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%. Conclusions: Patients with greater comorbidity, severity, and inflammatory markers were those treated with CTs. In severe patients, there is a trend towards the use of higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%.

Treatment of pregnant and early postpartum women with severe and critical COVID-19: experience at a tertiary center

“…In most patients (76%), the corticosteroid dose was higher than that used in the RECOVERY TRIAL [26] in view of the assumption that higher doses could provide better results in a disease with such an inflammatory response. However, up to the time of this study this issue remains unclarified [13,27,28].…”

Clusters of inflammation in COVID-19: descriptive analysis and prognosis on more than 15,000 patients from the Spanish SEMI-COVID-19 Registry

“…Of all the treatments tested in COVID-19, it is the immunosuppressants/immunomodulators (corticosteroids and tocilizumab) that have demonstrated the greatest effectiveness to date [16][17][18][19][20][21][22][23][24][25]. They are especially indicated in those patients with analytical parameters of inflammation such as the patients included in the present study.…”

Tools to Reduce Low-Value Care: Lessons From COVID-19 Pandemic Comment on "Key Factors that Promote Low-Value Care: Views of Experts From the United States, Canada, and the Netherlands"

“…For example: Hydroxychloroquine was used in the United States in more than half the patients in March 2020 and in only 0.8% of patients in August 2020. 4 In Spain, corticoisteroids 5 were used in 51.6% of the severe patients in March 2020 and in 85.7% in September 2020, while the inappropriate use of antibiotics 6 reached 35% in March 2020 and dropped to 28% in April 2020. How was it possible to reduce all these low-value practices within a limited period?…”