Objectives To assess the influence of corticosteroid pulses on 60-day mortality in hospitalized patients with severe COVID-19. Methods We designed a multicenter retrospective cohort study in three teaching hospitals of Castilla y León, Spain (865,096 people). We selected patients with confirmed COVID-19 and lung involvement with a pO2/FiO2<300, excluding those exposed to immunosuppressors before or during hospitalization, patients terminally ill at admission, or those who died in the first 24 hours. We performed a propensity score matching (PSM) adjusting covariates that modify the probability of being treated. Then, we used a Cox regression model in the PSM group to consider factors affecting mortality. Results From 2933 patients, 257 fulfilled the inclusion and exclusion criteria. 124 patients were on corticosteroid pulses (250 mg of methylprednisolone for three days), and 133 were not. 30.3% (37/122) of patients died in the corticosteroid pulse group and 42.9% (57/133) in the nonexposed cohort. These differences (12.6%, 95% CI [8·54-16.65]) were statically significant (log-rank 4.72, p = 0, 03). We performed PSM using the exact method. Mortality differences remained in the PSM group (log-rank 5.31, p = 0.021) and were still significant after a Cox regression model (HR for corticosteroid pulses 0.561; p = 0.039). Conclusions This study provides evidence about treatment with corticosteroid pulses in severe COVID-19 that might significantly reduce mortality. Strict inclusion and exclusion criteria with that selection process set a reliable frame to compare mortality in both the exposed and nonexposed groups.
【초록키워드】 COVID-19, Methylprednisolone, Treatment, Mortality, severe COVID-19, Hospitalization, lung involvement, hospital, Probability, Cohort, Patient, Spain, multicenter, Admission, PSM, patients, Evidence, propensity score matching, exclusion criteria, 24 hours, Cox regression model, retrospective cohort study, Factor, Frame, 95% CI, covariate, Inclusion, objective, selection process, reduce mortality, Result, selected, performed, died, significantly, remained, treated, provide, hospitalized patient, groups, affecting, modify, corticosteroid pulse, patients died, 【제목키워드】 Effect,