The use of methylprednisolone in COVID-19 patients: A propensity score matched retrospective cohort study

You, Xiang; Wu, Chao; Fu, Yucheng; He, Zonglin; Huang, Pin Fang; Chen, Gong Ping; Lin, Cui Hong; Ming, Wai Kit; Lin, Rong

doi:10.1371/journal.pone.0244128

Cited by 16 publications

(22 citation statements)

References 15 publications

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“…RT-PCR showed negative for SARS-CoV-2 on hospitalization day 10 in this patient, which was different from the previous study by You et al (2020) that stated methylprednisolone could not improve the prognosis of patients with COVID-19. Another study stated that patients without the use of methylprednisolone were more quickly to obtain negative results (11 days) of their nasopharyngeal swab tests of SARS-CoV-2 nucleic acid after treatment, compared to those receiving methylprednisolone (13.5 days) [24] .…”

Section: Discussionmentioning

confidence: 99%

Concurrent COVID-19 and Pneumocystis jirovecii pneumonia: The importance of radiological diagnostic and HIV testing

Anggraeni¹,

Soedarsono²,

Soeprijanto³

2021

Radiology Case Reports

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Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has changed the focus of healthcare and become a public health challenge around the world. The coinfection of SARS-CoV-2 with other microorganisms, including fungi, can cause difficult diagnosis and a worse prognosis. Pneumocystis jirovecii pneumonia (PJP) is a common opportunistic infection in human immunodeficiency virus (HIV) patients. However, sometimes the diagnosis is late presented after PJP finding on chest X-ray. We report a 24-year-old man with COVID-19 and PJP. Reverse transcriptase-polymerase chain reaction showed positive for SARS-CoV-2. HIV diagnosis was late presented after PJP finding on chest X-ray examination. HIV serology was positive with an absolute CD4+ count was 16 cells/mm 3 . He was treated with remdesivir IV, methylprednisolone IV, heparin, and cefoperazone-sulbactam IV. He was discharged after being admitted for 25 days. HIV treatment was started in outpatient services. Radiological diagnostic to diagnose concurrent COVID-19 and PJP pneumonia are important, especially in the setting where microscopic examination of sputum or Bronchoalveolar Lavage Fluid (BALF) is not available, or because BAL and sputum induction are aerosol-generating procedures that potentially increase the risk of COVID-19 transmission. HIV testing in COVID-19 patients was also should be considered as part of directed screening in patients presenting with features of PJP, especially for those with unknown HIV status. The determination of an appropriate corticosteroid dose is important to treat both COVID-19 and PJP with severe clinical features. Proper diagnosis and treatment co-infections are urgently needed in this current pandemic to reduce morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Concurrent COVID-19 and Pneumocystis jirovecii pneumonia: The importance of radiological diagnostic and HIV testing

Anggraeni¹,

Soedarsono²,

Soeprijanto³

2021

Radiology Case Reports

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“…Sensitivity analysis for betweenstudy heterogeneity and analytical methods was performed to show the robustness of the finding. e analysis showed that the result was stable except for the exclusion of three studies [18,21,33] that changed the conclusion (Figure 7). e rationale for the use of corticosteroids is to decrease the host inflammatory responses in the lungs, which may lead to acute lung injury and acute respiratory distress syndrome [6].…”

Section: Sensitivity Analysismentioning

confidence: 93%

“…In the 26 included studies [17-19, 21-23, 25-30, 32-35, 37-42, 44, 45, 47, 48] with 13,565 patients, there were no significant differences in mortality between the steroid and nonsteroid treatment groups (RR � 0.95; 95% CI: 0.80-1.13; p � 0.57, I 2 � 78%, p < 0.0001) (Figure 2). e sensitivity analysis showed that the exclusion of three studies [18,21,33] changed the above conclusion.…”

Section: Mortality Associated With Steroid Use In Patients Withmentioning

confidence: 96%

Severity and Mortality Associated with Steroid Use among Patients with COVID-19: A Systematic Review and Meta-Analysis

Sahilu

Sheleme

Melaku

2021

Interdisciplinary Perspectives on Infectious Diseases

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Background. There are controversial suggestions about steroid use to treat patients infected with COVID-19. Conclusive evidence regarding the use of steroids to treat COVID-19 is still lacking. This meta-analysis aimed to determine the mortality and severity associated with corticosteroid therapy compared to noncorticosteroid treatment in patients with COVID-19. Methods. The information was collected from electronic databases: PubMed, CINAHL, the Cochrane Library, clinicaltrials.gov, and Google scholar through January 30, 2021. Risk ratios (RRs) with 95% confidence intervals (CIs) were performed using random effect models. Endnote citation manager software version X9 for Windows was utilized to collect and organize search outcomes (into relevant and irrelevant studies) and to remove duplicate articles. Results. Thirty-two studies were included in the meta-analysis, including 14,659 COVID-19 patients. No significant differences in mortality between the steroid and nonsteroid treatment groups (RR = 0.95; 95% CI: 0.80–1.13; p = 0.57). There was no significant reduction in mortality in critically ill COVID-19 patients treated with corticosteroid (RR = 0.89; 95% CI: 0.62–1.27; p = 0.52). Significant differences were observed in severe disease conditions between the steroid and nonsteroid treatment groups (RR = 1.10; 95% CI, 1.03–1.19, p = 0.007). Conclusion. There was no significant difference in all-cause mortality between the steroid and nonsteroid treatment users’ of COVID-19 patients. There was no significant reduction of all-cause mortality in critically ill COVID-19 patients treated with corticosteroids.

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“…The results of three meta-analysis further support the employ of systemic corticosteroids in COVID-19 pneumonia, but it is worth to mention that the weight of RECOVERY PLOS ONE trial was more than 50 per cent in all of them and the magnitude of the effect was modest (OR ranging from 0.70 to 0.88) [41][42][43]. On the other hand, several propensity score matching (PSM) studies found no impact of corticosteroids on COVID-19 pneumonia outcome [44][45][46][47][48][49], while an increased mortality was observed in other report [50] and two additional PSM studies concluded that corticosteroid therapy was associated with lower mortality [51,52]. Therefore, considering all the available evidence, the role of corticosteroids remains controversial in non-critically ill patients who need supplemental oxygen.…”

Section: Risk Factors For Unfavorable Outcomementioning

confidence: 87%

COVID-19 pneumonia in Galicia (Spain): Impact of prognostic factors and therapies on mortality and need for mechanical ventilation

et al. 2021

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Introduction This study was aimed to identify risk factors associated with unfavorable outcomes (composite outcome variable: mortality and need for mechanical ventilation) in patients hospitalized in Galicia with COVID-19 pneumonia. Methods Retrospective, multicenter, observational study carried out in the 8 Galician tertiary hospitals. All Patients admitted with confirmed COVID-19 pneumonia from 1st of March to April 24th, 2020 were included. A multivariable logistic regression analysis was performed in order to identify the relationship between risk factors, therapeutic interventions and the composite outcome variable. Results A total of 1292 patients (56.1% male) were included. Two hundred and twenty-five (17.4%) died and 327 (25.3%) reached the main outcome variable. Age [odds ratio (OR) = 1.03 (95% confidence interval (CI): 1.01–1.04)], CRP quartiles 3 and 4 [OR = 2.24 (95% CI: 1.39–3.63)] and [OR = 3.04 (95% CI: 1.88–4.92)], respectively, Charlson index [OR = 1.16 (95%CI: 1.06–1.26)], SaO2 upon admission [OR = 0.93 (95% CI: 0.91–0.95)], hydroxychloroquine prescription [OR = 0.22 (95%CI: 0.12–0.37)], systemic corticosteroids prescription [OR = 1.99 (95%CI: 1.45–2.75)], and tocilizumab prescription [OR = 3.39 (95%CI: 2.15–5.36)], significantly impacted the outcome. Sensitivity analysis using different alternative logistic regression models identified consistently the ratio admissions/hospital beds as a predictor of the outcome [OR = 1.06 (95% CI: 1.02–1.11)]. Conclusion These findings may help to identify patients at hospital admission with a higher risk of death and may urge healthcare authorities to implement policies aimed at reducing deaths by increasing the availability of hospital beds.

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The use of methylprednisolone in COVID-19 patients: A propensity score matched retrospective cohort study

Cited by 16 publications

References 15 publications

Concurrent COVID-19 and Pneumocystis jirovecii pneumonia: The importance of radiological diagnostic and HIV testing

Concurrent COVID-19 and Pneumocystis jirovecii pneumonia: The importance of radiological diagnostic and HIV testing

Severity and Mortality Associated with Steroid Use among Patients with COVID-19: A Systematic Review and Meta-Analysis

COVID-19 pneumonia in Galicia (Spain): Impact of prognostic factors and therapies on mortality and need for mechanical ventilation

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