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dc.contributor.authorSalton, Francesco
dc.contributor.authorCasarin, Annalisa
dc.contributor.authorConfalonieri, Marco
dc.date.accessioned2020-10-17T00:11:24Z
dc.date.available2020-10-17T00:11:24Z
dc.date.issued2020-09-12
dc.identifier.citationSalton , F , Casarin , A & Confalonieri , M 2020 , ' Prolonged Low-Dose Methylprednisolone in Patients With Severe COVID-19 Pneumonia ' , Open Forum Infectious Diseases . https://doi.org/10.1093/ofid/ofaa421
dc.identifier.otherPURE: 22805682
dc.identifier.otherPURE UUID: 0a47e09f-d4e1-4aeb-8e4b-fd67f31a7656
dc.identifier.urihttp://hdl.handle.net/2299/23283
dc.description.abstractBackground In hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia, progression to acute respiratory failure requiring invasive mechanical ventilation (MV) is associated with significant morbidity and mortality. Severe dysregulated systemic inflammation is the putative mechanism. We hypothesize that early prolonged methylprednisolone (MP) treatment could accelerate disease resolution, decreasing the need for intensive care unit (ICU) admission and mortality. Methods We conducted a multicenter observational study to explore the association between exposure to prolonged, low-dose MP treatment and need for ICU referral, intubation, or death within 28 days (composite primary end point) in patients with severe COVID-19 pneumonia admitted to Italian respiratory high-dependency units. Secondary outcomes were invasive MV-free days and changes in C-reactive protein (CRP) levels. Results Findings are reported as MP (n = 83) vs control (n = 90). The composite primary end point was met by 19 vs 40 (adjusted hazard ratio [aHR], 0.41; 95% CI, 0.24–0.72). Transfer to ICU and invasive MV were necessary in 15 vs 27 (P = .07) and 14 vs 26 (P = .10), respectively. By day 28, the MP group had fewer deaths (6 vs 21; aHR, 0.29; 95% CI, 0.12–0.73) and more days off invasive MV (24.0 ± 9.0 vs 17.5 ± 12.8; P = .001). Study treatment was associated with rapid improvement in PaO2:FiO2 and CRP levels. The complication rate was similar for the 2 groups (P = .84). Conclusion In patients with severe COVID-19 pneumonia, early administration of prolonged MP treatment was associated with a significantly lower hazard of death (71%) and decreased ventilator dependence. Treatment was safe and did not impact viral clearance. A large randomized controlled trial (RECOVERY trial) has been performed that validates these findings. Clinical trial registration. ClinicalTrials.gov NCT04323592.en
dc.language.isoeng
dc.relation.ispartofOpen Forum Infectious Diseases
dc.subjectCOVID19 pneumonia
dc.subjectSTEROIDS
dc.titleProlonged Low-Dose Methylprednisolone in Patients With Severe COVID-19 Pneumoniaen
dc.contributor.institutionDepartment of Psychology and Sports Sciences
dc.contributor.institutionCentre for Health Services and Clinical Research
dc.contributor.institutionSchool of Life and Medical Sciences
dc.description.statusPeer reviewed
rioxxterms.versionVoR
rioxxterms.versionofrecordhttps://doi.org/10.1093/ofid/ofaa421
rioxxterms.typeJournal Article/Review
herts.preservation.rarelyaccessedtrue


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