A Retrospective Controlled Cohort Study of the Impact of Glucocorticoid Treatment in SARS-CoV-2 Infection Mortality

ABSTRACT Evidence to support the use of steroids in coronavirus disease 2019 (COVID-19) pneumonia is lacking. We aim to determine the impact of steroid use for COVID-19 pneumonia on hospital mortality. We performed a single-center retrospective cohort study in a university hospital in Madrid, Spain, during March of 2020. To determine the role of steroids in in-hospital mortality, patients admitted with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia and treated with steroids were compared to patients not treated with steroids, and we adjusted with a propensity score for patients on steroid treatment. Survival times were compared using the log rank test. Different steroid regimens were compared and adjusted with a second propensity score. During the study period, 463 out of 848 hospitalized patients with COVID-19 pneumonia fulfilled inclusion criteria. Among them, 396 (46.7%) patients were treated with steroids and 67 patients were not. Global mortality was 15.1%. The median time to steroid treatment from symptom onset was 10 days (interquartile range [IQR], 8 to 13 days). In-hospital mortality was lower in patients treated with steroids than in controls (13.9% [55/396] versus 23.9% [16/67]; hazard ratio [HR], 0.51 [95% confidence interval, 0.27 to 0.96]; P = 0.044). Steroid treatment reduced mortality by 41.8% relative to the mortality with no steroid treatment (relative risk reduction, 0.42 [95% confidence interval, 0.048 to 0.65]). Initial treatment with 1 mg/kg of body weight/day of methylprednisolone versus steroid pulses was not associated with in-hospital mortality (13.5% [42/310] versus 15.1% [13/86]; odds ratio [OR], 0.880 [95% confidence interval, 0.449 to 1.726]; P = 0.710). Our results show that the survival of patients with SARS-CoV-2 pneumonia is higher in patients treated with glucocorticoids than in those not treated. Rates of in-hospital mortality were not different between initial regimens of 1 mg/kg/day of methylprednisolone and glucocorticoid pulses.

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IMPACT OF GLUCOCORTICOID TREATMENT IN SARS-COV-2 INFECTION MORTALITY: A RETROSPECTIVE CONTROLLED COHORT STUDY

10.1101/2020.05.22.20110544 ◽

2020 ◽

Cited By ~ 6

Author(s):

Ana Fernández Cruz ◽

Belén Ruiz-Antorán ◽

Ana Muñoz Gómez ◽

Aránzazu Sancho López ◽

Patricia Mills Sánchez ◽

...

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Hospital Mortality ◽

Steroid Treatment ◽

University Hospital ◽

Rank Test ◽

Survival Times ◽

Glucocorticoid Treatment ◽

Beneficial Impact ◽

The Impact

ABSTRACTObjectiveWe aim to determine the impact of steroid use in COVID-19 pneumonia in-hospital mortality.DesignWe performed a single-centre retrospective cohort study.SettingA University hospital in Madrid, Spain, during March 2020.ParticipantsPatients admitted with SARS-CoV-2 pneumonia.ExposuresPatients treated with steroids were compared to patients not treated with steroids. A propensity-score for steroid treatment was developed. Different steroid regimens were also compared, and adjusted with a second propensity score.Main Outcomes and MeasuresTo determine the role of steroids in in-hospital mortality, univariable and multivariable analyses were performed, and adjusted including the propensity score as a covariate. Survival times were compared using a log-rank test.ResultsDuring the study period, 463 out of 848 hospitalized patients with COVID19 pneumonia fulfilled inclusion criteria. Among them, 396 (46.7%) consecutive patients were treated with steroids and 67 patients were assigned to the control cohort. Global mortality was 15.1%. Median time to steroid treatment from symptom onset was 10 days (IQR 8 to13). In-hospital mortality was lower in patients treated with steroids than in controls (13.9% [55/396] versus 23.9% [16/67], OR 0.51 [0.27 to 0.96], p= 0.044). Steroid treatment reduced mortality by 41.8% relative to no steroid treatment (RRR 0,42 [0.048 to 0.65). Initial treatment with 1 mg/kg/day of methylprednisolone (or equivalent) versus steroid pulses was not associated with in-hospital mortality (13.5% [42/310] versus 15.1% [13/86], OR 0.880 [0.449-1.726], p=0.710).ConclusionsOur results show that survival of patients with SARS-CoV2 pneumonia is higher in patients treated with glucocorticoids than in those not treated. In-hospital mortality was not different between initial regimens of 1 mg/kg/day of methylprednisolone or equivalent and glucocorticoid pulses. These results support the use of glucocorticoids in SARS-CoV2 infection.SummaryWe investigated in-hospital mortality of patients with SARS-CoV-2 pneumonia in a large series of patients treated with steroids compared to controls, and adjusted using a propensity score. Our results show a beneficial impact of steroid treatment in SARS-CoV-2 pneumonia.

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Real-Life Impact of Glucocorticoid Treatment in COVID-19 Mortality: A Multicenter Retrospective Study

Journal of Clinical Medicine ◽

10.3390/jcm10204678 ◽

2021 ◽

Vol 10 (20) ◽

pp. 4678

Author(s):

Ana Muñoz-Gómez ◽

Ana Fernández-Cruz ◽

Cristina Lavilla-Olleros ◽

Vicente Giner-Galvañ ◽

Cristina Ausín-García ◽

...

Keyword(s):

Propensity Score ◽

Confidence Interval ◽

Hospital Mortality ◽

Real Life ◽

Steroid Treatment ◽

Glucocorticoid Treatment ◽

Steroid Use ◽

Steroid Group ◽

Life Impact ◽

The Impact

We aimed to determine the impact of steroid use in COVID-19 in-hospital mortality, in a retrospective cohort study of the SEMICOVID19 database of admitted patients with SARS-CoV-2 laboratory-confirmed pneumonia from 131 Spanish hospitals. Patients treated with corticosteroids were compared to patients not treated with corticosteroids; and adjusted using a propensity-score for steroid treatment. From March–July 2020, 5.262 (35.26%) were treated with corticosteroids and 9.659 (64.73%) were not. In-hospital mortality overall was 20.50%; it was higher in patients treated with corticosteroids than in controls (28.5% versus 16.2%, OR 2.068 [95% confidence interval; 1.908 to 2.242]; p = 0.0001); however, when adjusting by occurrence of ARDS, mortality was significantly lower in the steroid group (43.4% versus 57.6%; OR 0.564 [95% confidence interval; 0.503 to 0.633]; p = 0.0001). Moreover, the greater the respiratory failure, the greater the impact on mortality of the steroid treatment. When adjusting these results including the propensity score as a covariate, in-hospital mortality remained significantly lower in the steroid group (OR 0.774 [0.660 to 0.907], p = 0.002). Steroid treatment reduced mortality by 24% relative to no steroid treatment (RRR 0.24). These results support the use of glucocorticoids in COVID-19 in this subgroup of patients.

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Statins’ safety and impact on the clinical outcomes in COVID-19 critically ill patients: A Multicenter, Cohort Study

10.21203/rs.3.rs-828175/v2 ◽

2021 ◽

Author(s):

Khalid Al Sulaiman ◽

Ohoud Aljuhani ◽

Ghazwa B. Korayem ◽

Ali F. Altebainawi ◽

Shmeylan Al Harbi ◽

...

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Hazard Ratio ◽

Icu Stay ◽

Markers Of Inflammation ◽

The Impact ◽

Statin Use

Abstract Purpose The complications of Severe Corona Virus Disease 2019 (COVID-19) are attributed to the overproduction of early response proinflammatory cytokines, causing a systemic hyperinflammatory state. Statins are potentially a potent adjuvant therapy in COVID-19 infection due to their pleiotropic and anti-inflammatory effects, which are independent of their cholesterol-lowering activity. This study investigates the impact of statin use on the outcome of critically ill patients with COVID-19. Methods A multicenter, retrospective cohort study of all adult critically ill patients with confirmed COVID-19 admitted to Intensive Care Units (ICUs) between March 1, 2020, and March 31, 2021. Eligible patients were classified into two groups based on statin use during ICU stay and were matched with a propensity score which was based on patient’s age and admission APACHE II and SOFA scores. The primary endpoint was in-hospital mortality. Other outcomes were considered secondary... Results A total of 1049 patients were eligible; 502 patients were included after propensity score matching (1:1 ratio). The 30-day (hazard ratio 0.75 (95% CI 0.58, 0.98), P = 0.03) and in-hospital mortality (hazard ratio 0.69 (95% CI 0.54, 0.89), P = 0.004) were significantly lower in patients who received statin therapy on multivariable cox proportional hazards regression analysis. Moreover, patients who received statin have a lower risk of hospital-acquired pneumonia (OR 0.48(95% CI 0.32, 0.69), P = < 0.001), lower levels of markers of inflammation on follow up and no increased risk of liver injury. Conclusion The use of statin during ICU stay in COVID-19 critically ill patients may have a beneficial role and survival benefits with a good safety profile.

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Comparison of Anesthesia Beginning at On-hours Versus Off-hours on Outcomes in Patients Undergoing Hip Surgery: A Retrospective, Propensity Score–matched Cohort Study

10.21203/rs.3.rs-847362/v1 ◽

2021 ◽

Author(s):

Jiayi Wu ◽

Shuang Zhang ◽

Xi Wu ◽

Wei Mei

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Hospital Mortality ◽

Renal Dysfunction ◽

Risk Ratio ◽

Pulmonary Infection ◽

Hip Surgery ◽

Hospital Length Of Stay ◽

Icu Admission ◽

The Impact

Abstract Objective: To explore the impact of the begin time of anesthesia on in-hospital mortality and early prognosis of patients undergoing hip surgery.Methods: All patients who had hip surgery between January 1, 2015, and December 31, 2020, were evaluated in this retrospective cohort study. The primary outcome was in-hospital mortality. Secondary outcomes were: (1) postoperative hospital length of stay (postoperative LOS) and total LOS; (2) ICU admission; (3) the ratio of postoperative complications, including renal dysfunction, anemia, hypotension, deep vein thrombosis (DVT), arrhythmia, coronary artery disease (CAD) or heart failure, pulmonary infection, electrolyte disturbance, hyoxemia and delirium; (4) intraoperative outcomes, including blood loss, urine volume, concentrated red blood cells (CRBC), fresh frozen plasma (FFP), equilibrium liquid, colloidal solution, intraoperative sufentanil, and using vasoactive drugs. A propensity score–matched analysis was used to adjust for confounders to make baseline characteristics more similar within the cohort. Results: We identified 1,843 patients, of whom 1,727 had anesthesia begun at on-hours and 116 had anesthesia begun at off-hours. Before propensity score matching (PSM), in-hospital mortality (risk ratio, 19.85; 95% CI, 4.39-89.78; P <0.001), postoperative LOS (11 days [8-16] vs. 9 days [7-14]; P =0.001) and total LOS (16 days [12-25.3] vs. 14 days [12-19]; P =0.020), the proportion of ICU admission (risk ratio, 4.70; 95% CI, 1.84-12.01; P <0.001), hypotension (risk ratio, 5.96; 95% CI, 1.84-19.29; P =0.004), pulmonary infection (risk ratio, 4.74; 95% CI, 1.98-11.33; P <0.001) and hyoxemia (risk ratio, 5.32; 95% CI, 1.88-15.03; P <0.001) was higher in the off-hours group. Intraoperative CRBC (0 U [0-2] vs. 0 U [0-0]; P <0.001), FFP (0 mL [0-37.5] vs. 0 mL [0-0]; P <0.001) and the intraoperative dosage of sufentanil (24.5 vs. 19.3 μg; P =0.003) was higher in the off-hours group. After PSM, 110 patients in the on-hours group were matched to similar patients in the off-hours group. Intraoperative CRBC (0 U [0-2] vs. 0 U [0-0]; P =0.040) and FFP (0 mL [0-0] vs. 0 mL [0-0]; P =0.015) was higher in the off-hours group. And postoperative renal dysfunction (risk ratio, 1.67; 95% CI, 0.86-3.21; P =0.050) and hyoxemia (4.5% vs. 0%; P =0.060) had a tendency to be different.Conclusion: Off-hours anesthesia for hip surgery is associated with statistically significant increases in intraoperative CRBC, FFP, and possibly associated with higher ratio of postoperative renal dysfunction and hyoxemia. These findings suggest that off-hours anesthesia, possibly by affecting the anesthetist’s judgment and decision making, could cause potential risks for hip surgery patients, which requires further exploration.

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Treatment with Zinc is Associated with Reduced In-Hospital Mortality Among COVID-19 Patients: A Multi-Center Cohort Study

10.21203/rs.3.rs-94509/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jennifer A. frontera ◽

Joseph O. Rahimian ◽

Shadi Yaghi ◽

Mengling Liu ◽

Ariane Lewis ◽

...

Keyword(s):

Sensitivity Analysis ◽

Cohort Study ◽

Propensity Score ◽

Hospital Mortality ◽

Mortality Rates ◽

Hospital Death ◽

Intracellular Zinc ◽

Zinc Levels ◽

The Impact ◽

Reduced Risk

Abstract Background: Zinc impairs replication of RNA viruses such as SARS-CoV-1, and may be effective against SARS-CoV-2. However, to achieve adequate intracellular zinc levels, administration with an ionophore, which increases intracellular zinc levels, may be necessary. We evaluated the impact of zinc with an ionophore (Zn+ionophore) on COVID-19 in-hospital mortality rates.Methods: A multicenter cohort study was conducted of 3,473 adult hospitalized patients with reverse-transcriptase-polymerase-chain-reaction (RT-PCR) positive SARS-CoV-2 infection admitted to four New York City hospitals between March 10 through May 20, 2020. Exclusion criteria were: death or discharge within 24h, comfort-care status, clinical trial enrollment, treatment with an IL-6 inhibitor or remdesivir. Patients who received Zn+ionophore were compared to patients who did not using multivariable time-dependent cox proportional hazards models for time to in-hospital death adjusting for confounders including age, sex, race, BMI, diabetes, week of admission, hospital location, sequential organ failure assessment (SOFA) score, intubation, acute renal failure, neurological events, treatment with corticosteroids, azithromycin or lopinavir/ritonavir and the propensity score of receiving Zn+ionophore. A sensitivity analysis was performed using a propensity score-matched cohort of patients who did or did not receive Zn+ionophore matched by age, sex and ventilator status.Results: Among 3,473 patients (median age 64, 1947 [56%] male, 522 [15%] ventilated, 545[16%] died), 1,006 (29%) received Zn+ionophore. Zn+ionophore was associated with a 24% reduced risk of in-hospital mortality (12% of those who received Zn+ionophore died versus 17% who did not; adjusted Hazard Ratio [aHR] 0.76, 95% CI 0.60-0.96, P=0.023). More patients who received Zn+ionophore were discharged home (72% Zn+ionophore vs 67% no Zn+ionophore, P=0.003) Neither Zn nor the ionophore alone were associated with decreased mortality rates. Propensity score-matched sensitivity analysis (N=1356) validated these results (Zn+ionophore aHR for mortality 0.63, 95%CI 0.44-0.91, P=0.015). There were no significant interactions for Zn+ionophore with other COVID-19 specific medications.Conclusions: Zinc with an ionophore was associated with increased rates of discharge home and a 24% reduced risk of in-hospital mortality among COVID-19 patients, while neither zinc alone nor the ionophore alone reduced mortality. Further randomized trials are warranted.

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Statins’ safety and impact on the clinical outcomes in COVID-19 critically ill patients: A Multicenter, Cohort Study

10.21203/rs.3.rs-828175/v1 ◽

2021 ◽

Author(s):

◽

Ohoud Aljuhani ◽

Ghazwa B. Korayem ◽

Ali F. Altebainawi ◽

Shmeylan Al Harbi ◽

...

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Hazard Ratio ◽

Icu Stay ◽

Markers Of Inflammation ◽

The Impact ◽

Statin Use

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Switching antifibrotics in patients with idiopathic pulmonary fibrosis: a multi-center retrospective cohort study

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01587-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yuzo Suzuki ◽

Kazutaka Mori ◽

Yuya Aono ◽

Masato Kono ◽

Hirotsugu Hasegawa ◽

...

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Disease Progression ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Survival Times ◽

Antifibrotic Therapy ◽

Median Period

Abstract Background Currently, there are two antifibrotics used to treat idiopathic pulmonary fibrosis (IPF): pirfenidone and nintedanib. Antifibrotics slow disease progression by reducing the annual decline of forced vital capacity (FVC), which possibly improves outcomes in IPF patients. During treatment, patients occasionally switch antifibrotic treatments. However, prognostic implication of changing antifibrotics has not yet been evaluated. Methods This multi-center retrospective cohort study examined 262 consecutive IPF patients who received antifibrotic therapy. Antifibrotic agents were switched in 37 patients (14.1%). The prognoses were compared between the patient cohort that switched antifibrotics (Switch-IPF) and those without (Non-Switch-IPF) using propensity-score matched analyses. Results The median period between the initiation of antifibrotic therapy and the drug switch was 25.8 (12.7–35.3) months. The most common reasons for the switch were disease progression (n = 17) followed by gastrointestinal disorders (n = 12). Of the 37 patients that switched antifibrotics, only eight patients disrupted switched antifibrotics by their adverse reactions. The overall prognosis of the Switch-IPF cohort was significantly better than the Non-Switch-IPF cohort (median periods: 67.2 vs. 27.1 months, p < 0.0001). In propensity-score matched analyses that were adjusted to age, sex, FVC (%), history of acute exacerbation, and usage of long-term oxygen therapy, the Switch-IPF cohort had significantly longer survival times than the Non-Switch-IPF group (median 67.2 vs. 41.3 months, p = 0.0219). The second-line antifibrotic therapy showed similar survival probabilities than those in first-line antifibrotic therapy in multistate model analyses. Conclusion Switching antifibrotics is feasible and may improve prognosis in patients with IPF. A further prospective study will be required to confirm clinical implication of switching the antifibrotics.

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In-hospital mortality after surgery: a retrospective cohort study in a Japanese university hospital

SpringerPlus ◽

10.1186/s40064-016-2279-1 ◽

2016 ◽

Vol 5 (1) ◽

Cited By ~ 5

Author(s):

Yo Shidara ◽

Yoshihisa Fujita ◽

Saiko Fukunaga ◽

Kae Ikeda ◽

Mayumi Uemura

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

University Hospital ◽

Japanese University

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In-hospital mortality in COVID-19 vs. pre-COVID-19 era in the Split-Dalmatia County, Croatia

European Journal of Public Health ◽

10.1093/eurpub/ckab165.068 ◽

2021 ◽

Vol 31 (Supplement_3) ◽

Author(s):

I Marasovic Šušnjara

Keyword(s):

Hospital Mortality ◽

Respiratory Diseases ◽

Score Test ◽

Additional Research ◽

University Hospital ◽

Complete Picture ◽

Cross Sectional ◽

Classification Of Diseases ◽

International Statistical Classification ◽

The Impact

Abstract Background The COVID-19 pandemic marked 2020 with numerous consequences for the health of the population. Therefore, this study aimed to explore whether the COVID-19 pandemic affected in-hospital mortality. Methods We employed a cross-sectional comparative study using two different time periods, pre-COVID-19 (2019 year) and COVID-19 era (2020 year) to explore possibilities of COVID-19 influences in-hospital mortality in Split-Dalmatia County, Croatia. The research used data from the national information system on hospitalizations from the Clinical Hospital Center Split, University Hospital Split. The indicators were statistically analyzed. The z-score test for two population proportions is used. Results In 2020, there was a significantly higher in-hospital mortality compared to 2019 (z = 9.0827; p < 0.00001), which was supported by a significant increase in mortality from respiratory diseases according to the comparison of disease categories of International Statistical Classification of Diseases and Related Health Problems (ICD-10) (z = 9.0427; p < 0.00001). Within hospital departments, significantly higher mortality was in the Intensive Care Unit (z = 5.2763; p < 0.00001) and the Infectious Diseases Department (z = 9.6982; p < 0.00001). Among deaths in 2020 with confirmed COVID-19, there were significantly more positive among deaths from respiratory diseases (z=-17.4462; p < 0.00001). There was no difference in mortality rates between 2020 and 2019 by age. Conclusions The results of the study indicate that COVID-19 has a contribution to hospital mortality. Given that the pandemic has not yet completed additional research, it will be necessary to obtain a more complete picture of the impact of COVID-19 on hospital mortality in Split-Dalmatia County, as well as in other regions and countries. Key messages The results of the study indicate that COVID-19 has a contribution to hospital mortality. Given that the pandemic has not yet completed additional research, it will be necessary to obtain a more complete picture of the impact of COVID-19 on hospital mortality.

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Impact of Influenza Vaccination on Mortality in the Oldest Old: A Propensity Score-Matched Cohort Study

Vaccines ◽

10.3390/vaccines8030356 ◽

2020 ◽

Vol 8 (3) ◽

pp. 356

Author(s):

Pauline Walzer ◽

Clémentine Estève ◽

Jeremy Barben ◽

Didier Menu ◽

Christine Cuenot ◽

...

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Propensity Score Matching ◽

Oldest Old ◽

Immunization Coverage ◽

All Cause Mortality ◽

Comorbidity Index ◽

The Impact

Influenza remains a major cause of illness and death in geriatric populations. While the influenza vaccine has successfully reduced morbidity and mortality, its effectiveness is suspected to decrease with age. The aim of this study was to assess the impact of influenza vaccination on all-cause mortality in very old ambulatory subjects. We conducted a prospective cohort study from 1 July 2016 to 31 June 2017 in a large unselected ambulatory population aged over 80 years. We compared all-cause mortality in vaccinated versus unvaccinated subjects after propensity-score matching, to control for age, sex and comorbidities. Among the 9149 patients included, with mean age 86 years, 4380 (47.9%) were vaccinated against influenza. In total, 5253 (57.4%) had at least one chronic disease. The most commonly vaccinated patients were those with chronic respiratory failure (76.3%) and the least commonly vaccinated were those suffering from Parkinson’s disease (28.5%). Overall, 2084 patients (22.8%) died during the study. After propensity score matching, the mortality was evaluated at 20.9% in the vaccinated group and 23.9% in the unvaccinated group (OR = 0.84 [0.75–0.93], p = 0.001). This decrease in mortality in the vaccinated group persisted whatever the age and Charlson Comorbidity index. In conclusion, nearly a half of this ambulatory elderly population received Influenza vaccine. After adjustment on comorbidities, influenza vaccination was associated with a significant decrease in all-cause mortality, even in the eldest multimorbid population. Improving immunization coverage in this frail older population is urgently needed.

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