Kent Owusu, BCCCP, BCPS, PharmD
Senior Care Signature Lead; Pharmacist, Critical Care
Yale New Haven Health
Arcadia, Florida
Disclosure information not submitted.
Mahmoud Ammar, BCCCP, PharmD, BCPS,
Critical Care Pharmacist
Yale New Haven Hospital
New Haven, Connecticut
Disclosure information not submitted.
Abdalla Ammar, PharmD, BCCCP, BCPS,
Critical Care Pharmacist, Neurocritical Care
New York Presbyterian Hospital - Weill Cornell Medical College
New York, NY
Disclosure information not submitted.
Adam Chess, MPH
Data Analyst, Joint Data Analytics Team
Yale New Haven Health, Connecticut, United States
Disclosure information not submitted.
Jonathan Siner, MD
Associate Professor Term; Clinical Section Chief, Section of Pulmonary, Critical Care and Sleep Med
Yale-New Haven Medical Center, United States
Disclosure information not submitted.
Elaine Fajardo, MD
Assistant Professor of Medicine (Pulmonary); Medical Director for Respiratory Therapy, Internal Med
Yale New Haven Hospital, United States
Disclosure information not submitted.
Astha Chichra, MBBS
Assistant Professor, Pulmonary, Critical Care & Sleep Medicine
Yale New Haven Hospital, Yale School of Medicine, United States
Disclosure information not submitted.
Title: Methylprednisolone Versus Usual Care for COVID-19-Associated Acute Respiratory Distress Syndrome
Introduction: Dysregulated inflammation is a hallmark of SARS-CoV-2 related acute respiratory distress syndrome (ARDS) pathogenesis. Corticosteroids (CS) have shown improved survival and ventilator-free days but the choice of corticosteroid, dose, and duration is less established. We assessed the impact of methylprednisolone (MP) vs no corticosteroid (NCS) in patients with COVID-19.
Methods: This was a single-center retrospective propensity-weighted case-control study. Adult patients admitted January–July2020 were included if they had a confirmed SARS-CoV-2 infection and excluded if they received CS other than MP. Primary endpoint was in-hospital mortality. Secondary outcomes were mechanical ventilation (MV)-free days,ICU and hospital length of stay (LOS),duration and need for invasive MV. Safety endpoints were hyperglycemia rates,positive cultures,14-day delirium-free days, and hypernatremia. Patient characteristics were compared using student’s t-test, chi-squared tests, Fisher’s exact, or Kruskal-Wallis tests as appropriate. A propensity score was developed via logistic regression. Multivariable inverse-propensity-weighted cox proportional hazards models were used for the main analysis.
Results: 1,663 patients (MP: n=358 vs.NCS: n=1305) met inclusion criteria and were included in the analysis. Median age (years) in both groups was similar; MP 66.5 vs. NCS 66.0, adj-p = 0.45.There were more males in the MP group, 60% vs. 46%, adj-p < 0.001. In-hospital mortality was not significantly different (MP 28% vs. NCS 10%) HR 1.12 (95%CI: 0.81–1.57), p = 0.55). In MV patients, in-hospital mortality was significantly lower (MP 37% vs. 43% NCS, HR 0.46 (95%CI: 0.26–0.81), p=0.01. ICU LOS and MV-free days were not significantly different. Longer hospital LOS was found for patients who received MP; 13.3 vs. 11.1, p = 0.001. No differences were noted in other safety measures except hyperglycemia, which was higher in patients who received MP (63%) vs. NCS (46%), p < 0.001. In ICU admitted patients, there were more 14-day delirium-free days in the MP cohort MP: 963/1160 days, (83%) vs. NCS (538/716 days, 75%), p < 0.001.
Conclusions: MP improved mortality in COVID-19 patients with moderate-severe ARDS requiring invasive MV. MP did not increase infection risk and was safe but did not affect outcomes in less severe COVID-19 patients.