Risk Factors for ARDS and Progression to Death Among COVID-19 PatientsDaniel Kaul, MD reviewing Wu C et al. JAMA Intern Med 2020 Mar 13
In an observational study, methylprednisolone treatment was associated with improved outcomes among those with acute respiratory distress syndrome.March 23, 2020
Risk Factors for ARDS and Progression to Death Among COVID-19 Patients
Daniel Kaul, MD reviewing Wu C et al. JAMA Intern Med 2020 Mar 13
In an observational study, methylprednisolone treatment was associated with improved outcomes among those with acute respiratory distress syndrome.
Patients with COVID-19 are at risk for acute respiratory distress syndrome (ARDS) and death from respiratory failure.
Age and medical comorbidities have been consistently described as risk factors for poor outcomes. In an additional cohort of hospitalized patients from China, investigators now describe risk factors for ARDS, death during hospitalization, and the effect of treatment of ARDS with methylprednisolone.
The study group consisted of 201 patients with confirmed COVID-19 admitted to a single hospital in Wuhan from December 25, 2019, to January 26, 2020. Median age was 51 years (interquartile range, 43–60 years); 63.7% were male, and 32.8% had comorbidities. Median hospital stay was 13 days (IQR, 10–16 days), 33% required mechanical ventilation, and median time from admission to ARDS was 2 days (IQR, 1–4 days). Although the numbers of patients tested varied, laboratory abnormalities were common, including elevated lactate dehydrogenase in 194 (98%), elevated high-sensitivity C-reactive protein in 166 (85.6%), elevated interleukin-6 in 60 (48.8%), and elevated D-dimer in 44 (23.3%). Age ≥65 years, neutrophilia, and organ or coagulation dysfunction were associated with ARDS and death. Among those with ARDS, treatment with methylprednisolone was associated with significantly better outcomes: 23 of 50 (46%) methylprednisolone recipients died compared with 21 of 34 (61.8%) nonrecipients (hazard ratio, 0.38).
COMMENT
This cohort of COVID-19 cases occurred early in the epidemic and many had elevated inflammatory and coagulation markers associated with poor prognosis in other studies (Lancet 2020 Mar 11; [e-pub]). Although corticosteroids appeared to be beneficial in this cohort, this has not been a consistent finding, and WHO guidelines do not recommend adjunctive corticosteroids outside of a clinical trial.
EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Daniel Kaul, MD at time of publication
Consultant/Advisory Board TSRL Incorporated
Grant/Research Support Chimerix; Merck & Co.; National Institute of Allergy and Infectious Diseases; Shire
CITATION(S):
Wu C et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020 Mar 13; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links).
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Θέμα: Κορονοϊός ( COVID-19 ) (Αναγνώστηκε 298728 φορές)
24 Απριλίου 2020, 01:44:56