Steroids in severe COVID-19 patients: A retrospective analysis on the first pandemics in Lombardy


Submitted: 3 June 2021
Accepted: 16 August 2021
Published: 21 September 2021
Abstract Views: 519
PDF: 216
Appendix: 64
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Authors

  • Beatrice Vergnano Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza, Italy.
  • Serena Calcinati Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza, Italy.
  • Davide Signori Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza; Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.
  • Annalisa Benini Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza, Italy.
  • Maria Rosa Pozzi Medical Area Department, Rheumatology Unit, San Gerardo Hospital, Monza, Italy.
  • Luisa Verga Medical Area Department, Hematology Division, San Gerardo Hospital, Monza, Italy.
  • Jonata Pizzagalli Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza, Italy.
  • Paolo Bonfanti Department of Medicine and Surgery, University of Milano-Bicocca, Milano; Clinic of Infectious Diseases,San Gerardo Hospital, Monza, Italy.
  • Giacomo Bellani Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza; Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy. https://orcid.org/0000-0002-3089-205X
  • Giuseppe Foti Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza; Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.

The pathogenesis of COVID-19 appears to be characterized by a dysregulated immune response. During the first pandemic wave in Lombardy, we started to administer glucocorticoids to some patients with severe respiratory failure requiring support with Continuous Positive Airway Pressure (CPAP) therapy. We retrospectively collected data to identify the effect of glucocorticoids in this COVID-19 particular population. With a multidisciplinary consensus, we administered to selected patients with severe COVID-19 disease (PaO2/FiO2 159±71 mmHg) 0,91 mg/kg/die of methylprednisolone equivalent dose after a median of 8 days of hospitalization. In our study we compared 57 patients from the steroid group with 123 from the control group: the event of invasive mechanical ventilation or death was reduced by 43% between steroid group and control group (19.3 % vs. 34.1 % respectively, p=0.001) and mortality was reduced by about 31% between steroid and usual care alone (15.8 % vs. 22.8 % respectively, p=0.011). Corticosteroids in selected COVID-19 patients may have a relevant impact on outcome, better profiling of the heterogeneity of this disease may be essential to guarantee the best treatment choices.


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Vergnano, B., Calcinati, S., Signori, D., Benini, A., Pozzi, M. R., Verga, L., Pizzagalli, J., Bonfanti, P., Bellani, G., & Foti, G. (2021). Steroids in severe COVID-19 patients: A retrospective analysis on the first pandemics in Lombardy. Emergency Care Journal, 17(3). https://doi.org/10.4081/ecj.2021.9888

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