Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study.
Identifieur interne : 000B54 ( Main/Corpus ); précédent : 000B53; suivant : 000B55Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study.
Auteurs : Michele Bartoletti ; Lorenzo Marconi ; Luigia Scudeller ; Livia Pancaldi ; Sara Tedeschi ; Maddalena Giannella ; Matteo Rinaldi ; Linda Bussini ; Ilaria Valentini ; Anna Filomena Ferravante ; Antonella Potalivo ; Elisa Marchionni ; Giacomo Fornaro ; Renato Pascale ; Zeno Pasquini ; Massimo Puoti ; Marco Merli ; Francesco Barchiesi ; Francesca Volpato ; Arianna Rubin ; Annalisa Saracino ; Tommaso Tonetti ; Paolo Gaibani ; Vito Marco Ranieri ; Pierluigi Viale ; Francesco CristiniSource :
- Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [ 1469-0691 ] ; 2021.
English descriptors
- KwdEn :
- Adrenal Cortex Hormones (therapeutic use), Adult (MeSH), Aged (MeSH), Antiviral Agents (therapeutic use), COVID-19 (drug therapy), COVID-19 (mortality), COVID-19 (pathology), Critical Illness (MeSH), Female (MeSH), Heparin, Low-Molecular-Weight (therapeutic use), Hospital Mortality (MeSH), Hospitals (MeSH), Humans (MeSH), Hydroxychloroquine (therapeutic use), Italy (MeSH), Length of Stay (statistics & numerical data), Male (MeSH), Middle Aged (MeSH), Odds Ratio (MeSH), Respiratory Distress Syndrome (drug therapy), Respiratory Distress Syndrome (mortality), Respiratory Distress Syndrome (pathology), Retrospective Studies (MeSH), SARS-CoV-2 (drug effects), SARS-CoV-2 (pathogenicity), Severity of Illness Index (MeSH), Survival Analysis (MeSH), Treatment Outcome (MeSH).
- MESH :
- chemical , therapeutic use : Adrenal Cortex Hormones, Antiviral Agents, Heparin, Low-Molecular-Weight, Hydroxychloroquine.
- geographic : Italy.
- drug effects : SARS-CoV-2.
- drug therapy : COVID-19, Respiratory Distress Syndrome.
- mortality : COVID-19, Respiratory Distress Syndrome.
- pathogenicity : SARS-CoV-2.
- pathology : COVID-19, Respiratory Distress Syndrome.
- statistics & numerical data : Length of Stay.
- Adult, Aged, Critical Illness, Female, Hospital Mortality, Hospitals, Humans, Male, Middle Aged, Odds Ratio, Retrospective Studies, Severity of Illness Index, Survival Analysis, Treatment Outcome.
Abstract
OBJECTIVE
To assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19).
METHODS
A multicentre observational study was performed from 22 February through 30 June 2020. We included consecutive adult patients with severe COVID-19, defined as respiratory rate ≥30 breath per minute, oxygen saturation ≤93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ≤300 mm Hg. We excluded patients being treated with other immunomodulant drugs, receiving low-dose corticosteroids and receiving corticosteroids 72 hours after admission. The primary endpoint was 30-day mortality from hospital admission. The main exposure variable was corticosteroid therapy at a dose of ≥0.5 mg/kg of prednisone equivalents. It was introduced as binomial covariate in a logistic regression model for the primary endpoint and inverse probability of treatment weighting using the propensity score.
RESULTS
Of 1717 patients with COVID-19 evaluated, 513 were included in the study, and of these, 170 (33%) were treated with corticosteroids. During hospitalization, 166 patients (34%) met the criteria of the primary outcome (60/170, 35% in the corticosteroid group and 106/343, 31% in the noncorticosteroid group). At multivariable analysis corticosteroid treatment was not associated with lower 30-day mortality rate (adjusted odds ratio, 0.59; 95% confidence interval (CI), 0.20-1.74; p 0.33). After inverse probability of treatment weighting, corticosteroids were not associated with lower 30-day mortality (average treatment effect, 0.05; 95% CI, -0.02 to 0.09; p 0.12). However, subgroup analysis revealed that in patients with PO2/FiO2 < 200 mm Hg at admission (135 patients, 52 (38%) treated with corticosteroids), corticosteroid treatment was associated with a lower risk of 30-day mortality (23/52, 44% vs. 45/83, 54%; adjusted odds ratio, 0.20; 95% CI, 0.04-0.90; p 0.036).
CONCLUSIONS
The effect of corticosteroid treatment on mortality might be limited to critically ill COVID-19 patients.
DOI: 10.1016/j.cmi.2020.09.014
PubMed: 32971254
PubMed Central: PMC7506332
Links to Exploration step
pubmed:32971254Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study.</title><author><name sortKey="Bartoletti, Michele" sort="Bartoletti, Michele" uniqKey="Bartoletti M" first="Michele" last="Bartoletti">Michele Bartoletti</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy. Electronic address: m.bartoletti@unibo.it.</nlm:affiliation></affiliation></author><author><name sortKey="Marconi, Lorenzo" sort="Marconi, Lorenzo" uniqKey="Marconi L" first="Lorenzo" last="Marconi">Lorenzo Marconi</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Rimini-Forlì-Cesena Hospitals, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Scudeller, Luigia" sort="Scudeller, Luigia" uniqKey="Scudeller L" first="Luigia" last="Scudeller">Luigia Scudeller</name><affiliation><nlm:affiliation>Clinical Trials Team, Scientific Direction, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Pancaldi, Livia" sort="Pancaldi, Livia" uniqKey="Pancaldi L" first="Livia" last="Pancaldi">Livia Pancaldi</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Tedeschi, Sara" sort="Tedeschi, Sara" uniqKey="Tedeschi S" first="Sara" last="Tedeschi">Sara Tedeschi</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Giannella, Maddalena" sort="Giannella, Maddalena" uniqKey="Giannella M" first="Maddalena" last="Giannella">Maddalena Giannella</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Rinaldi, Matteo" sort="Rinaldi, Matteo" uniqKey="Rinaldi M" first="Matteo" last="Rinaldi">Matteo Rinaldi</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Bussini, Linda" sort="Bussini, Linda" uniqKey="Bussini L" first="Linda" last="Bussini">Linda Bussini</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Valentini, Ilaria" sort="Valentini, Ilaria" uniqKey="Valentini I" first="Ilaria" last="Valentini">Ilaria Valentini</name><affiliation><nlm:affiliation>Unit of Pneumology, ASL della Romagna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Ferravante, Anna Filomena" sort="Ferravante, Anna Filomena" uniqKey="Ferravante A" first="Anna Filomena" last="Ferravante">Anna Filomena Ferravante</name><affiliation><nlm:affiliation>Unit of Pneumology, ASL della Romagna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Potalivo, Antonella" sort="Potalivo, Antonella" uniqKey="Potalivo A" first="Antonella" last="Potalivo">Antonella Potalivo</name><affiliation><nlm:affiliation>Department of Emergency, Anaesthesia and Intensive Care Section, Infermi Hospital, Rimini, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Marchionni, Elisa" sort="Marchionni, Elisa" uniqKey="Marchionni E" first="Elisa" last="Marchionni">Elisa Marchionni</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Rimini-Forlì-Cesena Hospitals, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Fornaro, Giacomo" sort="Fornaro, Giacomo" uniqKey="Fornaro G" first="Giacomo" last="Fornaro">Giacomo Fornaro</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Pascale, Renato" sort="Pascale, Renato" uniqKey="Pascale R" first="Renato" last="Pascale">Renato Pascale</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Pasquini, Zeno" sort="Pasquini, Zeno" uniqKey="Pasquini Z" first="Zeno" last="Pasquini">Zeno Pasquini</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy; Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria, Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Puoti, Massimo" sort="Puoti, Massimo" uniqKey="Puoti M" first="Massimo" last="Puoti">Massimo Puoti</name><affiliation><nlm:affiliation>Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Merli, Marco" sort="Merli, Marco" uniqKey="Merli M" first="Marco" last="Merli">Marco Merli</name><affiliation><nlm:affiliation>Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Barchiesi, Francesco" sort="Barchiesi, Francesco" uniqKey="Barchiesi F" first="Francesco" last="Barchiesi">Francesco Barchiesi</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy; Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria, Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Volpato, Francesca" sort="Volpato, Francesca" uniqKey="Volpato F" first="Francesca" last="Volpato">Francesca Volpato</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Rubin, Arianna" sort="Rubin, Arianna" uniqKey="Rubin A" first="Arianna" last="Rubin">Arianna Rubin</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Saracino, Annalisa" sort="Saracino, Annalisa" uniqKey="Saracino A" first="Annalisa" last="Saracino">Annalisa Saracino</name><affiliation><nlm:affiliation>Department of Biomedical Sciences and Human Oncology, Infectious Disease Unit, University of Bari, Policlinico di Bari, Bari, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Tonetti, Tommaso" sort="Tonetti, Tommaso" uniqKey="Tonetti T" first="Tommaso" last="Tonetti">Tommaso Tonetti</name><affiliation><nlm:affiliation>Intensive Care Unit, Department of Medical and Surgical Sciences, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Gaibani, Paolo" sort="Gaibani, Paolo" uniqKey="Gaibani P" first="Paolo" last="Gaibani">Paolo Gaibani</name><affiliation><nlm:affiliation>Centro di riferimento regionale per le emergenze microbiologiche (CRREM), Clinical Microbiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Policlinico Sant'Orsola, Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Ranieri, Vito Marco" sort="Ranieri, Vito Marco" uniqKey="Ranieri V" first="Vito Marco" last="Ranieri">Vito Marco Ranieri</name><affiliation><nlm:affiliation>Intensive Care Unit, Department of Medical and Surgical Sciences, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Viale, Pierluigi" sort="Viale, Pierluigi" uniqKey="Viale P" first="Pierluigi" last="Viale">Pierluigi Viale</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Cristini, Francesco" sort="Cristini, Francesco" uniqKey="Cristini F" first="Francesco" last="Cristini">Francesco Cristini</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Rimini-Forlì-Cesena Hospitals, Italy.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2021">2021</date><idno type="RBID">pubmed:32971254</idno><idno type="pmid">32971254</idno><idno type="doi">10.1016/j.cmi.2020.09.014</idno><idno type="pmc">PMC7506332</idno><idno type="wicri:Area/Main/Corpus">000B54</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000B54</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study.</title><author><name sortKey="Bartoletti, Michele" sort="Bartoletti, Michele" uniqKey="Bartoletti M" first="Michele" last="Bartoletti">Michele Bartoletti</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy. Electronic address: m.bartoletti@unibo.it.</nlm:affiliation></affiliation></author><author><name sortKey="Marconi, Lorenzo" sort="Marconi, Lorenzo" uniqKey="Marconi L" first="Lorenzo" last="Marconi">Lorenzo Marconi</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Rimini-Forlì-Cesena Hospitals, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Scudeller, Luigia" sort="Scudeller, Luigia" uniqKey="Scudeller L" first="Luigia" last="Scudeller">Luigia Scudeller</name><affiliation><nlm:affiliation>Clinical Trials Team, Scientific Direction, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Pancaldi, Livia" sort="Pancaldi, Livia" uniqKey="Pancaldi L" first="Livia" last="Pancaldi">Livia Pancaldi</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Tedeschi, Sara" sort="Tedeschi, Sara" uniqKey="Tedeschi S" first="Sara" last="Tedeschi">Sara Tedeschi</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Giannella, Maddalena" sort="Giannella, Maddalena" uniqKey="Giannella M" first="Maddalena" last="Giannella">Maddalena Giannella</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Rinaldi, Matteo" sort="Rinaldi, Matteo" uniqKey="Rinaldi M" first="Matteo" last="Rinaldi">Matteo Rinaldi</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Bussini, Linda" sort="Bussini, Linda" uniqKey="Bussini L" first="Linda" last="Bussini">Linda Bussini</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Valentini, Ilaria" sort="Valentini, Ilaria" uniqKey="Valentini I" first="Ilaria" last="Valentini">Ilaria Valentini</name><affiliation><nlm:affiliation>Unit of Pneumology, ASL della Romagna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Ferravante, Anna Filomena" sort="Ferravante, Anna Filomena" uniqKey="Ferravante A" first="Anna Filomena" last="Ferravante">Anna Filomena Ferravante</name><affiliation><nlm:affiliation>Unit of Pneumology, ASL della Romagna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Potalivo, Antonella" sort="Potalivo, Antonella" uniqKey="Potalivo A" first="Antonella" last="Potalivo">Antonella Potalivo</name><affiliation><nlm:affiliation>Department of Emergency, Anaesthesia and Intensive Care Section, Infermi Hospital, Rimini, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Marchionni, Elisa" sort="Marchionni, Elisa" uniqKey="Marchionni E" first="Elisa" last="Marchionni">Elisa Marchionni</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Rimini-Forlì-Cesena Hospitals, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Fornaro, Giacomo" sort="Fornaro, Giacomo" uniqKey="Fornaro G" first="Giacomo" last="Fornaro">Giacomo Fornaro</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Pascale, Renato" sort="Pascale, Renato" uniqKey="Pascale R" first="Renato" last="Pascale">Renato Pascale</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Pasquini, Zeno" sort="Pasquini, Zeno" uniqKey="Pasquini Z" first="Zeno" last="Pasquini">Zeno Pasquini</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy; Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria, Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Puoti, Massimo" sort="Puoti, Massimo" uniqKey="Puoti M" first="Massimo" last="Puoti">Massimo Puoti</name><affiliation><nlm:affiliation>Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Merli, Marco" sort="Merli, Marco" uniqKey="Merli M" first="Marco" last="Merli">Marco Merli</name><affiliation><nlm:affiliation>Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Barchiesi, Francesco" sort="Barchiesi, Francesco" uniqKey="Barchiesi F" first="Francesco" last="Barchiesi">Francesco Barchiesi</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy; Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria, Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Volpato, Francesca" sort="Volpato, Francesca" uniqKey="Volpato F" first="Francesca" last="Volpato">Francesca Volpato</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Rubin, Arianna" sort="Rubin, Arianna" uniqKey="Rubin A" first="Arianna" last="Rubin">Arianna Rubin</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Saracino, Annalisa" sort="Saracino, Annalisa" uniqKey="Saracino A" first="Annalisa" last="Saracino">Annalisa Saracino</name><affiliation><nlm:affiliation>Department of Biomedical Sciences and Human Oncology, Infectious Disease Unit, University of Bari, Policlinico di Bari, Bari, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Tonetti, Tommaso" sort="Tonetti, Tommaso" uniqKey="Tonetti T" first="Tommaso" last="Tonetti">Tommaso Tonetti</name><affiliation><nlm:affiliation>Intensive Care Unit, Department of Medical and Surgical Sciences, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Gaibani, Paolo" sort="Gaibani, Paolo" uniqKey="Gaibani P" first="Paolo" last="Gaibani">Paolo Gaibani</name><affiliation><nlm:affiliation>Centro di riferimento regionale per le emergenze microbiologiche (CRREM), Clinical Microbiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Policlinico Sant'Orsola, Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Ranieri, Vito Marco" sort="Ranieri, Vito Marco" uniqKey="Ranieri V" first="Vito Marco" last="Ranieri">Vito Marco Ranieri</name><affiliation><nlm:affiliation>Intensive Care Unit, Department of Medical and Surgical Sciences, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Viale, Pierluigi" sort="Viale, Pierluigi" uniqKey="Viale P" first="Pierluigi" last="Viale">Pierluigi Viale</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Cristini, Francesco" sort="Cristini, Francesco" uniqKey="Cristini F" first="Francesco" last="Cristini">Francesco Cristini</name><affiliation><nlm:affiliation>Infectious Diseases Unit, Rimini-Forlì-Cesena Hospitals, Italy.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases</title><idno type="eISSN">1469-0691</idno><imprint><date when="2021" type="published">2021</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adrenal Cortex Hormones (therapeutic use)</term><term>Adult (MeSH)</term><term>Aged (MeSH)</term><term>Antiviral Agents (therapeutic use)</term><term>COVID-19 (drug therapy)</term><term>COVID-19 (mortality)</term><term>COVID-19 (pathology)</term><term>Critical Illness (MeSH)</term><term>Female (MeSH)</term><term>Heparin, Low-Molecular-Weight (therapeutic use)</term><term>Hospital Mortality (MeSH)</term><term>Hospitals (MeSH)</term><term>Humans (MeSH)</term><term>Hydroxychloroquine (therapeutic use)</term><term>Italy (MeSH)</term><term>Length of Stay (statistics & numerical data)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Odds Ratio (MeSH)</term><term>Respiratory Distress Syndrome (drug therapy)</term><term>Respiratory Distress Syndrome (mortality)</term><term>Respiratory Distress Syndrome (pathology)</term><term>Retrospective Studies (MeSH)</term><term>SARS-CoV-2 (drug effects)</term><term>SARS-CoV-2 (pathogenicity)</term><term>Severity of Illness Index (MeSH)</term><term>Survival Analysis (MeSH)</term><term>Treatment Outcome (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Adrenal Cortex Hormones</term><term>Antiviral Agents</term><term>Heparin, Low-Molecular-Weight</term><term>Hydroxychloroquine</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Italy</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>SARS-CoV-2</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>COVID-19</term><term>Respiratory Distress Syndrome</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>COVID-19</term><term>Respiratory Distress Syndrome</term></keywords><keywords scheme="MESH" qualifier="pathogenicity" xml:lang="en"><term>SARS-CoV-2</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>COVID-19</term><term>Respiratory Distress Syndrome</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Length of Stay</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Critical Illness</term><term>Female</term><term>Hospital Mortality</term><term>Hospitals</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Odds Ratio</term><term>Retrospective Studies</term><term>Severity of Illness Index</term><term>Survival Analysis</term><term>Treatment Outcome</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>To assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19).</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>A multicentre observational study was performed from 22 February through 30 June 2020. We included consecutive adult patients with severe COVID-19, defined as respiratory rate ≥30 breath per minute, oxygen saturation ≤93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ≤300 mm Hg. We excluded patients being treated with other immunomodulant drugs, receiving low-dose corticosteroids and receiving corticosteroids 72 hours after admission. The primary endpoint was 30-day mortality from hospital admission. The main exposure variable was corticosteroid therapy at a dose of ≥0.5 mg/kg of prednisone equivalents. It was introduced as binomial covariate in a logistic regression model for the primary endpoint and inverse probability of treatment weighting using the propensity score.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Of 1717 patients with COVID-19 evaluated, 513 were included in the study, and of these, 170 (33%) were treated with corticosteroids. During hospitalization, 166 patients (34%) met the criteria of the primary outcome (60/170, 35% in the corticosteroid group and 106/343, 31% in the noncorticosteroid group). At multivariable analysis corticosteroid treatment was not associated with lower 30-day mortality rate (adjusted odds ratio, 0.59; 95% confidence interval (CI), 0.20-1.74; p 0.33). After inverse probability of treatment weighting, corticosteroids were not associated with lower 30-day mortality (average treatment effect, 0.05; 95% CI, -0.02 to 0.09; p 0.12). However, subgroup analysis revealed that in patients with PO2/FiO2 < 200 mm Hg at admission (135 patients, 52 (38%) treated with corticosteroids), corticosteroid treatment was associated with a lower risk of 30-day mortality (23/52, 44% vs. 45/83, 54%; adjusted odds ratio, 0.20; 95% CI, 0.04-0.90; p 0.036).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>The effect of corticosteroid treatment on mortality might be limited to critically ill COVID-19 patients.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32971254</PMID><DateCompleted><Year>2020</Year><Month>12</Month><Day>31</Day></DateCompleted><DateRevised><Year>2020</Year><Month>12</Month><Day>31</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1469-0691</ISSN><JournalIssue CitedMedium="Internet"><Volume>27</Volume><Issue>1</Issue><PubDate><Year>2021</Year><Month>Jan</Month></PubDate></JournalIssue><Title>Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases</Title><ISOAbbreviation>Clin Microbiol Infect</ISOAbbreviation></Journal><ArticleTitle>Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study.</ArticleTitle><Pagination><MedlinePgn>105-111</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S1198-743X(20)30563-2</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.cmi.2020.09.014</ELocationID><Abstract><AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">To assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19).</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">A multicentre observational study was performed from 22 February through 30 June 2020. We included consecutive adult patients with severe COVID-19, defined as respiratory rate ≥30 breath per minute, oxygen saturation ≤93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ≤300 mm Hg. We excluded patients being treated with other immunomodulant drugs, receiving low-dose corticosteroids and receiving corticosteroids 72 hours after admission. The primary endpoint was 30-day mortality from hospital admission. The main exposure variable was corticosteroid therapy at a dose of ≥0.5 mg/kg of prednisone equivalents. It was introduced as binomial covariate in a logistic regression model for the primary endpoint and inverse probability of treatment weighting using the propensity score.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Of 1717 patients with COVID-19 evaluated, 513 were included in the study, and of these, 170 (33%) were treated with corticosteroids. During hospitalization, 166 patients (34%) met the criteria of the primary outcome (60/170, 35% in the corticosteroid group and 106/343, 31% in the noncorticosteroid group). At multivariable analysis corticosteroid treatment was not associated with lower 30-day mortality rate (adjusted odds ratio, 0.59; 95% confidence interval (CI), 0.20-1.74; p 0.33). After inverse probability of treatment weighting, corticosteroids were not associated with lower 30-day mortality (average treatment effect, 0.05; 95% CI, -0.02 to 0.09; p 0.12). However, subgroup analysis revealed that in patients with PO2/FiO2 < 200 mm Hg at admission (135 patients, 52 (38%) treated with corticosteroids), corticosteroid treatment was associated with a lower risk of 30-day mortality (23/52, 44% vs. 45/83, 54%; adjusted odds ratio, 0.20; 95% CI, 0.04-0.90; p 0.036).</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">The effect of corticosteroid treatment on mortality might be limited to critically ill COVID-19 patients.</AbstractText><CopyrightInformation>Copyright © 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Bartoletti</LastName><ForeName>Michele</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy. Electronic address: m.bartoletti@unibo.it.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Marconi</LastName><ForeName>Lorenzo</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Infectious Diseases Unit, Rimini-Forlì-Cesena Hospitals, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Scudeller</LastName><ForeName>Luigia</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Clinical Trials Team, Scientific Direction, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pancaldi</LastName><ForeName>Livia</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tedeschi</LastName><ForeName>Sara</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Giannella</LastName><ForeName>Maddalena</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rinaldi</LastName><ForeName>Matteo</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bussini</LastName><ForeName>Linda</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Valentini</LastName><ForeName>Ilaria</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>Unit of Pneumology, ASL della Romagna, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ferravante</LastName><ForeName>Anna Filomena</ForeName><Initials>AF</Initials><AffiliationInfo><Affiliation>Unit of Pneumology, ASL della Romagna, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Potalivo</LastName><ForeName>Antonella</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Emergency, Anaesthesia and Intensive Care Section, Infermi Hospital, Rimini, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Marchionni</LastName><ForeName>Elisa</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Infectious Diseases Unit, Rimini-Forlì-Cesena Hospitals, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Fornaro</LastName><ForeName>Giacomo</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pascale</LastName><ForeName>Renato</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pasquini</LastName><ForeName>Zeno</ForeName><Initials>Z</Initials><AffiliationInfo><Affiliation>Infectious Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy; Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria, Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Puoti</LastName><ForeName>Massimo</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Merli</LastName><ForeName>Marco</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Barchiesi</LastName><ForeName>Francesco</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Infectious Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy; Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria, Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Volpato</LastName><ForeName>Francesca</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rubin</LastName><ForeName>Arianna</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Saracino</LastName><ForeName>Annalisa</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Biomedical Sciences and Human Oncology, Infectious Disease Unit, University of Bari, Policlinico di Bari, Bari, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tonetti</LastName><ForeName>Tommaso</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Intensive Care Unit, Department of Medical and Surgical Sciences, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gaibani</LastName><ForeName>Paolo</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Centro di riferimento regionale per le emergenze microbiologiche (CRREM), Clinical Microbiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Policlinico Sant'Orsola, Bologna, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ranieri</LastName><ForeName>Vito Marco</ForeName><Initials>VM</Initials><AffiliationInfo><Affiliation>Intensive Care Unit, Department of Medical and Surgical Sciences, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Viale</LastName><ForeName>Pierluigi</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cristini</LastName><ForeName>Francesco</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Infectious Diseases Unit, Rimini-Forlì-Cesena Hospitals, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><CollectiveName>PREDICO Study Group</CollectiveName></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016448">Multicenter Study</PublicationType><PublicationType UI="D064888">Observational Study</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>09</Month><Day>22</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Clin Microbiol Infect</MedlineTA><NlmUniqueID>9516420</NlmUniqueID><ISSNLinking>1198-743X</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000305">Adrenal Cortex Hormones</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000998">Antiviral Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D006495">Heparin, Low-Molecular-Weight</NameOfSubstance></Chemical><Chemical><RegistryNumber>4QWG6N8QKH</RegistryNumber><NameOfSubstance UI="D006886">Hydroxychloroquine</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000305" MajorTopicYN="N">Adrenal Cortex Hormones</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000998" MajorTopicYN="N">Antiviral Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000401" MajorTopicYN="Y">mortality</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016638" MajorTopicYN="N">Critical Illness</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006495" MajorTopicYN="N">Heparin, Low-Molecular-Weight</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017052" MajorTopicYN="N">Hospital Mortality</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006761" MajorTopicYN="N">Hospitals</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006886" MajorTopicYN="N">Hydroxychloroquine</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007558" MajorTopicYN="N" Type="Geographic">Italy</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007902" MajorTopicYN="N">Length of Stay</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016017" MajorTopicYN="N">Odds Ratio</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012128" MajorTopicYN="N">Respiratory Distress Syndrome</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000401" MajorTopicYN="Y">mortality</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000086402" MajorTopicYN="N">SARS-CoV-2</DescriptorName><QualifierName UI="Q000187" MajorTopicYN="N">drug effects</QualifierName><QualifierName UI="Q000472" MajorTopicYN="Y">pathogenicity</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012720" 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