scholarly journals Intubation is Safe in Respiratory Failure Associated with Septic Shock: An Observational Study

2020 ◽  
Author(s):  
Ting Yang ◽  
Yongchun Shen ◽  
John G. Park ◽  
Phillip J Schulte ◽  
Andrew C Hanson ◽  
...  
Keyword(s):  
Septic Shock ◽  
Respiratory Failure ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Medical Center ◽  
Invasive Mechanical Ventilation ◽  
Hospital Length Of Stay ◽  
Hemodynamic Deterioration ◽  
The Impact

Abstract BackgroundAcute respiratory failure associated with sepsis contributes to higher in-hospital mortality. Intubation and invasive mechanical ventilation is a common rescue procedure. However, the 2016 International Guidelines for Management of Sepsis and Septic Shock does not provide any recommendation on indication nor timing of intubation. Timely intubation may improve outcome. The decision to intubate those patients is often hampered by the fear of further hemodynamic deterioration following intubation. MethodsThis study aimed at evaluating the impact of timely intubation on outcome in sepsis associated respiratory failure. We conducted an ancillary analysis of a prospective registry od adult ICU patients with septic shock admitted to the medical ICU in a tertiary medical center, between April 30th, 2014 and December 31st, 2017. All cases of sepsis with lactate >4 mmol/L, mean arterial pressure <65 mmHg, or vasopressor use after 30 mL/kg fluid boluses and suspected or confirmed infection. Patients who remained hospitalized at 24 hours following sepsis onset were separated into intubated and non-intubated groups. The primary outcome was hospital mortality. Univariate and multivariable analyses were used, adjusted for admission characteristics and stabilization of shock within 6 hours. In a secondary analysis, time-dependent propensity score matching was used to match intubated and non-intubated patients.ResultsWe identified 345 (33%) patients intubated within 24 hours and 707 (67%) not intubated. Intubated patients were younger, transferred more often from an outside facility, had higher severity of illness scores, more lung infection, achieved blood pressure goals more often but less often lactate normalization within 6 hours. The crude in-hospital mortality was higher, 89 (26%) vs. 82 (12%), p<0.001, as were ICU mortality, and ICU and hospital length of stay. After adjustment, intubation showed no effect on hospital mortality but fewer hospital-free days through day 28. After 1:1 propensity score matching, there was no difference in hospital mortality, but fewer hospital-free days in the intubated group. ConclusionsIntubation within 24 hours of sepsis onset was safe and not associated with hospital mortality, but was associated with less 28-day hospital-free days. Intubation should not be discouraged in appropriate patients with septic shock.

scholarly journals Temporal Trends in Sepsis Incidence and Mortality in Patients With Cancer in the US Population

2021 ◽  
Vol 30 (4) ◽  
pp. e71-e79
Author(s):  
Michael A. Liu ◽  
Brianna R. Bakow ◽  
Tzu-Chun Hsu ◽  
Jia-Yu Chen ◽  
Ke-Ying Su ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Cox Regression ◽  
Temporal Trends ◽  
Mortality Rates ◽  
Hazard Ratio ◽  
Patients With Cancer ◽  
Incidence And Mortality ◽  
The Impact

Background Few population-based studies assess the impact of cancer on sepsis incidence and mortality. Objectives To evaluate epidemiological trends of sepsis in patients with cancer. Methods This retrospective cohort study included adults (≥20 years old) identified using sepsis-indicator International Classification of Diseases codes from the Nationwide Inpatient Sample database (2006-2014). A generalized linear model was used to trend incidence and mortality. Outcomes in patients with cancer and patients without cancer were compared using propensity score matching. Cox regression modeling was used to calculate hazard ratios for mortality rates. Results The study included 13 996 374 patients, 13.6% of whom had cancer. Gram-positive infections were most common, but the incidence of gram-negative infections increased at a greater rate. Compared with patients without cancer, those with cancer had significantly higher rates of lower respiratory tract (35.0% vs 31.6%), intra-abdominal (5.5% vs 4.6%), fungal (4.8% vs 2.9%), and anaerobic (1.2% vs 0.9%) infections. Sepsis incidence increased at a higher rate in patients with cancer than in those without cancer, but hospital mortality rates improved equally in both groups. After propensity score matching, hospital mortality was higher in patients with cancer than in those without cancer (hazard ratio, 1.25; 95% CI, 1.24-1.26). Of patients with sepsis and cancer, those with lung cancer had the lowest survival (hazard ratio, 1.65) compared with those with breast cancer, who had the highest survival. Conclusions Cancer patients are at high risk for sepsis and associated mortality. Research is needed to guide sepsis monitoring and prevention in patients with cancer.

FA03.05: NEOADJUVANT CHEMOTHERAPY OR CHEMORADIOTHERAPY FOR ADENOCARCINOMA OF THE ESOPHAGUS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 7-7
Author(s):  
Els Visser ◽  
David Edholm ◽  
Mark Smithers ◽  
Iain Thomson ◽  
Bryan Burmeister ◽  
...  
Keyword(s):  
Overall Survival ◽  
Postoperative Complications ◽  
Neoadjuvant Chemotherapy ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Survival Rates ◽  
Neoadjuvant Chemoradiotherapy ◽  
Treatment Modalities ◽  
The Impact

Abstract Background Multimodality treatment of patients with esophageal adenocarcinoma (EAC) improve survival, but the optimal treatment strategy remains undetermined. The aim of this study was to compare outcomes in patients undergoing neoadjuvant chemotherapy (nCT) and neoadjuvant chemoradiotherapy (nCRT) for EAC. Methods Patients who underwent nCT or nCRT followed by surgery for EAC were identified from a prospective database (2000–2017) and included in this study. After propensity score matching, we compared the impact of the treatments on postoperative complications, in-hospital mortality, pathological outcomes and survival rates. Results Of the 396 eligible patients, 262 patients were analysed following propensity score matching. This resulted in 131 patients in the nCT group versus 131 patients in the nCRT group. There were no significant differences between the nCT and nCRT groups for overall complications (59% vs 57%, P = 0.802) or in-hospital mortality (2% vs 0%, P = 0.156). Patients who had nCRT had more R0 resections (93% vs. 83%, P = 0.013), and a higher pathological complete response rate (15% vs. 5%, P < 0.001). The pattern of recurrence was similar (P = 0.753) and there were no differences in 5-year disease-free survival rates (nCT vs nCRT; 39% vs 39%, P = 0.879) or 5-year overall survival rates (nCT vs nCRT; 44% vs 33%, P = 0.645). Conclusion In this study no differences between nCT and nCRT were seen in postoperative complications and in-hospital mortality in patients treated for EAC. Inspite of improved complete resection and pathological response there was no difference in the overall survival between the treatment modalities. Disclosure All authors have declared no conflicts of interest.

scholarly journals Impact of Sepsis Identification and Treatment Time on In-Hospital Mortality, Length of Stay, and Hours in the Intensive Care Unit

2021 ◽  
Author(s):  
Sylvia EK Sudat
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Length Of Stay ◽  
Mortality Reduction ◽  
Sepsis Screening ◽  
The Impact

Objective: The objective of this study was to examine the impact of timely treatment and identification of sepsis on patient outcomes at Sutter Health, a mixed-payer healthcare system in northern California, US. Methods: This observational, retrospective analysis considered electronic health record (EHR) data for individuals who presented with sepsis during 2016-17 at any of Sutter Health's 22 emergency departments (ED). Impacts were assessed for the timing of broad-spectrum antibiotic and intravenous (IV) fluid initiation, first vital signs, sepsis screening, and lactate results. Outcomes were in-hospital mortality, hospital length of stay (LOS) and intensive care unit (ICU) hours for patients discharged alive. Results: The final sample size was 35,847 (N=9,638 severe sepsis, N=5,309 septic shock). Early fluid initiation had the largest estimated impacts: a mortality reduction of 2.85%[2.03%,3.68%] overall and 2.94%[1.44%,4.48%] for severe sepsis (within 1 hour of sepsis presentation), and 14.66%[9.23%,20.07%] for septic shock (within 3 hours); reduced LOS (days) 1.39[1.08,1.71] overall, 2.30[1.31,3.21] severe sepsis, 3.07[1.21,4.94] septic shock; and fewer ICU hours 25.93[16.95,34.66] overall, 35.06[14.7,56.99] severe sepsis, 41.99[15.70,70.68] septic shock (within 3 hours). Sepsis screening within 30 minutes was also associated with mortality reductions (3.88%[2.96%,4.90%] overall, 1.74%[0.08%,3.50%] severe sepsis, 6.78%[3.12%,10.33%] septic shock). The greatest improvement opportunity was estimated for joint initiation of antibiotics and IV fluids, with a modest additional mortality reduction of 0.80%[0.47%,1.17%] overall, 0.77%[0.34%,1.19%] severe sepsis, 2.94%[1.83%,3.97%] septic shock; LOS reduction of 0.37[0.28,0.46] overall, 0.29[0.17,0.43] severe sepsis, 0.25[0.01,0.51] septic shock (within 1 hour); ICU hours reduction of 4.85[3.26,6.57] overall, 5.07[2.55,7.67] severe sepsis, 3.85[1.69,6.24] septic shock (within 3 hours).

scholarly journals Bed-to-Bed Transfer Program Among Patients Who Need Hospitalization in a Crowded Emergency Department in Taiwan

2021 ◽  
Author(s):  
Nai-Wen Ku ◽  
Chu-Lin Tsai ◽  
Shyr-Chyr Chen ◽  
Chien-Hua Huang ◽  
Cheng-Chung Fang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Medical Records ◽  
Medical Center ◽  
Transfer Program ◽  
Medical Centers ◽  
Regional Hospitals

Background: Emergency department (ED) crowding is a universal issue. In Taiwan, patients with common medical problems prefer to visit ED of medical centers, resulting in overcrowding. Thus, a bed-to-bed transfer program has been implemented since 2014. However, there was few studies that compared clinical outcomes among patients who choose to stay in medical centers to those being transferred to regional hospitals. The aim of this study was to explore the transfer rate, delineate the factors related to patient transfer, and clarify the influence upon the program outcomes. Methods: A retrospective cohort study was conducted using demographic and clinical disease factors from the patient electronic referral system, electronic medical records (EMRs) of a medical center in Taipei, and response to referrals from regional hospitals. The study included adult patients who were assessed as appropriate for transfer in 2016. We analyzed the outcomes (length of stay and mortality rate) between the referrals were accepted and refused using propensity score matching. Results: Of the 1759 patients eligible for transfer to regional hospitals, 420 patients (24%) accepted the referral. Medical records were obtained from the regional hospitals for 283 patients (67%). After propensity score matching, the results showed that interhospital transfer resulted in similar median total length of stay (8.7 days in the medical center vs 7.9 days in regional hospitals; P=.245). In-hospital mortality was low for both groups (3.1% in the medical center vs 1.3% in regional hospitals; P=.344). Conclusion: Transfer from an overcrowded ED in a medical center to regional hospitals in eligible patients results in non-significant outcome of total length of stay. With the caveat of an underpowered sample, we did not find statistically significant differences in in-hospital mortality. This healthcare delivery model may be used in other cities facing similar problems of ED overcrowding.

Clinical Outcomes Associated with Degree of Hypernatremia in Neurocritically Ill Patients

2021 ◽  
Author(s):  
Yun Im Lee ◽  
Joonghyun Ahn ◽  
Jeong-Am Ryu
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Serum Sodium ◽  
Multivariable Analysis ◽  
Tertiary Hospital ◽  
Propensity Score Matching Analysis ◽  
Neurosurgical Patients ◽  
The Impact

Abstract Background: Hypernatremia is a common complication encountered during the treatment of neurocritically ill patients. However, it is unclear whether clinical outcomes correlate with the severity of hypernatremia in such patients. Therefore, we investigated the impact of hypernatremia on mortality of these patients, depending on the degree of hypernatremia.Methods: Among neurosurgical patients admitted to the intensive care unit (ICU) in a tertiary hospital from January 2013 to December 2019, patients who were hospitalized in the ICU for more than 5 days and whose serum sodium levels were obtained during ICU admission were included. Hypernatremia was defined as the highest serum sodium level exceeding 150 mEq/L observed. We classified the patients into four subgroups according to the severity of hypernatremia and performed propensity score matching analysis.Results: Among 1,146 patients, 353 patients (30.8%) showed hypernatremia. Based on propensity score matching, 290 pairs were included in the analysis. The hypernatremia group had higher rates of in-hospital mortality and 28-day mortality in both overall and matched population (both p < 0.001 and p = 0.001, respectively). In multivariable analysis of propensity score-matched population, moderate and severe hypernatremia were significantly associated with in-hospital mortality (adjusted odds ratio [OR]: 4.58, 95% confidence interval [CI]: 2.15 – 9.75 and adjusted OR: 6.93, 95% CI: 3.46 – 13.90, respectively) and 28-day mortality (adjusted OR: 3.51, 95% CI: 1.54 – 7.98 and adjusted OR: 10.60, 95% CI: 5.10 – 21.90, respectively) compared with the absence of hypernatremia. However, clinical outcomes, including in-hospital mortality and 28-day mortality, were not significantly different between the group without hypernatremia and the group with mild hypernatremia (p = 0.720 and p = 0.690, respectively). The mortality rates of patients with moderate and severe hypernatremia were significantly higher in both overall and matched population. Interestingly, the mild hypernatremia group of matched population showed the best survival rate.Conclusions: Moderate and severe hypernatremia were associated with poor clinical outcomes in neurocritically ill patients. However, the prognosis of patients with mild hypernatremia was similar with that of patients without hypernatremia. Therefore, mild hypernatremia may be allowed during treatment of intracranial hypertension using hyperosmolar therapy.

scholarly journals Impact of using non-rebreathing mask in patients with respiratory failure

2020 ◽  
Author(s):  
Chao-Jui Li ◽  
Yan-Ren Lin ◽  
Chien-Chih Chen ◽  
Xin-Hong Lin ◽  
Po-Chun Chuang
Keyword(s):  
Respiratory Failure ◽  
Mortality Rate ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Pulmonary Disease ◽  
Research Database ◽  
Treatment Groups ◽  
Non Invasive ◽  
Medical Institutions ◽  
The Impact

Abstract Background Liberal oxygen therapy might increase the mortality rate of patients. Non-rebreathing mask (NRM) is a high-flow, non-invasive oxygen device that can provide oxygen concentration up to 95%. This study aimed to determine the impact of using NRM in patients with respiratory failure. Methods This retrospective cohort study was conducted in four medical institutions in Taiwan. Data were extracted from the Chang Gung Research Database between January 2010 and December 2016. The association between mortality and NRM use in patients with respiratory failure in the emergency department was analysed. Before receiving ventilator support, patients were divided into the NRM treatment and no NRM treatment groups. A 1:4 propensity score matching was conducted. Regarding the duration of NRM use, treatments were grouped as 0 hour, 0–1 hour, 1–2 hours, and > 2 hours. Results A total of 18749 patients were included, with 1074 using NRM. After the 1:4 propensity score matching, 1028 patients using NRM and 4112 patients not using NRM were analysed. The 72-hour and 30-day mortality rates were 14.8%, 14.1%, 10.4%, and 11.3% and 29.1%, 28.5%, 27.5%, and 35.5% in the 0 hour, 0–1 hour, 1–2 hour, and > 2 hour treatment groups, respectively. Patients with respiratory failure due to pulmonary disease using NRM (> 2 hours) for a prolonged period had a higher mortality rate than patients not using NRM (OR: 1.4, 95% CI: 1.06–1.74). Conclusions Prolonged use of NRM (> 2 hours) in patients with respiratory failure due to pulmonary disease possibly results in an increased mortality rate.

scholarly journals Diagnosis and outcome of acute respiratory failure in immunocompromised patients after bronchoscopy

2019 ◽  
Vol 54 (1) ◽  
pp. 1802442 ◽  
Author(s):  
Philippe R. Bauer ◽  
Sylvie Chevret ◽  
Hemang Yadav ◽  
Sangeeta Mehta ◽  
Peter Pickkers ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Propensity Score Matching ◽  
Diagnostic Yield ◽  
Noninvasive Testing ◽  
Bivariate Analysis ◽  
Immunocompromised Patients ◽  
Increased Risk

ObjectiveWe wished to explore the use, diagnostic capability and outcomes of bronchoscopy added to noninvasive testing in immunocompromised patients. In this setting, an inability to identify the cause of acute hypoxaemic respiratory failure is associated with worse outcome. Every effort should be made to obtain a diagnosis, either with noninvasive testing alone or combined with bronchoscopy. However, our understanding of the risks and benefits of bronchoscopy remains uncertain.Patients and methodsThis was a pre-planned secondary analysis of Efraim, a prospective, multinational, observational study of 1611 immunocompromised patients with acute respiratory failure admitted to the intensive care unit (ICU). We compared patients with noninvasive testing only to those who had also received bronchoscopy by bivariate analysis and after propensity score matching.ResultsBronchoscopy was performed in 618 (39%) patients who were more likely to have haematological malignancy and a higher severity of illness score. Bronchoscopy alone achieved a diagnosis in 165 patients (27% adjusted diagnostic yield). Bronchoscopy resulted in a management change in 236 patients (38% therapeutic yield). Bronchoscopy was associated with worsening of respiratory status in 69 (11%) patients. Bronchoscopy was associated with higher ICU (40%versus28%; p<0.0001) and hospital mortality (49%versus41%; p=0.003). The overall rate of undiagnosed causes was 13%. After propensity score matching, bronchoscopy remained associated with increased risk of hospital mortality (OR 1.41, 95% CI 1.08–1.81).ConclusionsBronchoscopy was associated with improved diagnosis and changes in management, but also increased hospital mortality. Balancing risk and benefit in individualised cases should be investigated further.

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

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.

scholarly journals The Impact of EGDT on Sepsis Mortality in a Single Tertiary Care Center in Lebanon

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Christopher El Khuri ◽  
Gilbert Abou Dagher ◽  
Ali Chami ◽  
Ralph Bou Chebl ◽  
Tarek Amoun ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Care Center ◽  
Tertiary Care ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy ◽  
Tertiary Center ◽  
The Impact

Background. EGDT (Early Goal Directed Therapy) or some portion of EGDT has been shown to decrease mortality secondary to sepsis and septic shock. Objective. Our study aims to assess the effect of adopting this approach in the emergency department on in-hospital mortality secondary to sepsis/septic shock in Lebanon. Hypothesis. Implementation of the EGDT protocol of sepsis in ED will decrease in-hospital mortality. Methods. Our retrospective study included 290 adult patients presenting to the ED of a tertiary center in Lebanon with severe sepsis and/or septic shock. 145 patients between years 2013 and 2014 who received protocol care were compared to 145 patients treated by standard care between 2010 and 2012. Data from the EHR were retrieved about patients’ demographics, medical comorbidities, and periresuscitation parameters. A multivariate analysis using logistic regression for the outcome in-hospital mortality after adjusting for protocol use and other confounders was done and AOR was obtained for the protocol use. 28-day mortality, ED, and hospital length of stay were compared between the two groups. Results. The most common infection site in the protocol arm was the lower respiratory tract (42.1%), and controls suffered more from UTIs (33.8%). Patients on protocol care had lower in-hospital mortality than that receiving usual care, 31.7% versus 47.6% (p=0.006) with an AOR of 0.429 (p =0.018). Protocol patients received more fluids at 6 and 24 hours (3.8 ± 1.7 L and 6.1 ± 2.1 L) compared to the control group (2.7 ± 2.0 L and 4.9 ± 2.8 L p=<0.001). Time to and duration of vasopressor use, choice of appropriate antibiotics, and length of ED stay were not significantly different between the two groups. Conclusion. EGDT- (Early Goal Directed Therapy-) based sepsis protocol implementation in EDs decreases in-hospital mortality in developing countries. Adopting this approach in facilities with limited resources, ICU capabilities, and prehospital systems may have a pronounced benefit.

scholarly journals High-Dose Methylprednisolone Pulses for 3 Days vs. Low-Dose Dexamethasone for 10 Days in Severe, Non-Critical COVID-19: A Retrospective Propensity Score Matched Analysis

2021 ◽  
Vol 10 (19) ◽  
pp. 4465
Author(s):  
José María Mora-Luján ◽  
Manel Tuells ◽  
Abelardo Montero ◽  
Francesc Formiga ◽  
Narcís A. Homs ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
Invasive Mechanical Ventilation ◽  
Hospital Length Of Stay ◽  
High Dose ◽  
Icu Admission ◽  
High Dose Methylprednisolone

Corticosteroids are largely recommended in patients with severe COVID-19. However, evidence to support high-dose methylprednisolone (MP) pulses is not as robust as that demonstrated for low-dose dexamethasone (DXM) in the RECOVERY trial. This is a retrospective cohort study on severe, non-critically ill patients with COVID-19, comparing 3-day MP pulses ≥ 100 mg/day vs. DXM 6 mg/day for 10 days. The primary outcome was in-hospital mortality, and the secondary outcomes were need of intensive care unit (ICU) admission or invasive mechanical ventilation (IMV). Propensity-score matching (PSM) analysis was applied. From March 2020 to April 2021, a total of 2,284 patients were admitted to our hospital due to severe, non-critically ill COVID-19, and of these, 189 (8.3%) were treated with MP, and 493 (21.6%) with DXM. The results showed that patients receiving MP showed higher in-hospital mortality (31.2% vs. 17.8%, p < 0.001), need of ICU admission (29.1% vs. 20.5%, p = 0.017), need of IMV (25.9% vs. 13.8, p < 0.001), and median hospital length of stay (14 days vs. 11 days, p < 0.001). Our results suggest that treatment with low-dose DXM for 10 days is superior to 3 days of high-dose MP pulses in preventing in-hospital mortality and need for ICU admission or IMV in severe, non-critically ill patients with COVID-19.

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