CovidSeniorV1, Main, Exploration, bibRecord, 000233

Second week methyl-prednisolone pulses improve prognosis in patients with severe coronavirus disease 2019 pneumonia: An observational comparative study using routine care data.

Identifieur interne : 000233 ( Main/Exploration ); précédent : 000232; suivant : 000234

Second week methyl-prednisolone pulses improve prognosis in patients with severe coronavirus disease 2019 pneumonia: An observational comparative study using routine care data.

Auteurs : Guillermo Ruiz-Irastorza [Espagne] ; Jose-Ignacio Pijoan [Espagne] ; Elena Bereciartua [Espagne] ; Susanna Dunder [Espagne] ; Jokin Dominguez [Espagne] ; Paula Garcia-Escudero [Espagne] ; Alejandro Rodrigo [Espagne] ; Carlota Gomez-Carballo [Espagne] ; Jimena Varona [Espagne] ; Laura Guio [Espagne] ; Marta Ibarrola [Espagne] ; Amaia Ugarte [Espagne] ; Agustin Martinez-Berriotxoa [Espagne]

Source :

PloS one [ 1932-6203 ] ; 2020.

RBID : pubmed:32960899

Descripteurs français

KwdFr :
- Adulte d'âge moyen (MeSH), Espagne (MeSH), Facteurs de risque (MeSH), Facteurs temps (MeSH), Femelle (MeSH), Glucocorticoïdes (usage thérapeutique), Humains (MeSH), Infections à coronavirus (anatomopathologie), Infections à coronavirus (diagnostic), Inflammation (MeSH), Intubation trachéale (MeSH), Mâle (MeSH), Méthylprednisolone (administration et posologie), Méthylprednisolone (pharmacologie), Méthylprednisolone (usage thérapeutique), Oxygène (sang), Pandémies (MeSH), Pneumopathie virale (anatomopathologie), Pneumopathie virale (diagnostic), Pronostic (MeSH), Risque (MeSH), Sujet âgé (MeSH), Études rétrospectives (MeSH).
MESH :
- administration et posologie : Méthylprednisolone.
- anatomopathologie : Infections à coronavirus, Pneumopathie virale.
- diagnostic : Infections à coronavirus, Pneumopathie virale.
- pharmacologie : Méthylprednisolone.
- sang : Oxygène.
- usage thérapeutique : Glucocorticoïdes, Méthylprednisolone.
- Adulte d'âge moyen, Espagne, Facteurs de risque, Facteurs temps, Femelle, Humains, Inflammation, Intubation trachéale, Mâle, Pandémies, Pronostic, Risque, Sujet âgé, Études rétrospectives.
Wicri :
- geographic : Espagne.

English descriptors

KwdEn :
- Aged (MeSH), Coronavirus Infections (diagnosis), Coronavirus Infections (pathology), Female (MeSH), Glucocorticoids (therapeutic use), Humans (MeSH), Inflammation (MeSH), Intubation, Intratracheal (MeSH), Male (MeSH), Methylprednisolone (administration & dosage), Methylprednisolone (pharmacology), Methylprednisolone (therapeutic use), Middle Aged (MeSH), Oxygen (blood), Pandemics (MeSH), Pneumonia, Viral (diagnosis), Pneumonia, Viral (pathology), Prognosis (MeSH), Retrospective Studies (MeSH), Risk (MeSH), Risk Factors (MeSH), Spain (MeSH), Time Factors (MeSH).
MESH :
- chemical , administration & dosage : Methylprednisolone.
- chemical , blood : Oxygen.
- chemical , pharmacology : Methylprednisolone.
- chemical , therapeutic use : Glucocorticoids, Methylprednisolone.
- geographic : Spain.
- diagnosis : Coronavirus Infections, Pneumonia, Viral.
- pathology : Coronavirus Infections, Pneumonia, Viral.
- Aged, Female, Humans, Inflammation, Intubation, Intratracheal, Male, Middle Aged, Pandemics, Prognosis, Retrospective Studies, Risk, Risk Factors, Time Factors.

Abstract

OBJECTIVE

To analyze the effects of a short course of methyl-prednisolone pulses (MP) during the second week of disease (week-2) in patients with severe coronavirus disease 2019 (COVID-19) pneumonia.

METHODS

Comparative observational study using data collected from routine care at Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain in patients with COVID-19 pneumonia. We compared patients who received week-2-MP (125-250 mg/d x3) with those who did not, with the end-points time to death and time to death or endotracheal intubation.

RESULTS

We included 242 patients with COVID-19 pneumonia and elevated inflammatory markers at admission. Sixty-one patients (25%) received week-2-MP. Twenty-two patients (9%) died and 31 (12.8%) suffered death or intubation. The adjusted HRs for death and death or intubation for patients in the week-2-MP group were 0.35 (95%CI 0.11 to 1.06, p = 0.064) and 0.33 (95%CI 0.13 to 0.84, p = 0.020), respectively. These differences were specifically seen in the subcohort of patients with a SpO2/FiO2 at day 7 lower than 353 (adjusted HR 0.31, 95% CI 0.08 to 1.12, p = 0.073 and HR 0.34, 95%CI 0.12 to 0.94, p = 0.038, respectively) but not in patients with higher SpO2/FiO2. Patients receiving out-of-week-2-MP, non-pulse glucocorticoids or no glucocorticoids had an increased adjusted risk for both outcomes compared with week-2-MP group: HR 5.04 (95% CI 0.91-27.86), HR 10.09 (95% CI 2.14-47.50), HR 4.14 (95% CI 0.81-21.23), respectively, for death; HR 7.38 (95% CI 1.86-29.29), HR 13.71 (95% CI 3.76-50.07), HR 3.58 (95% CI 0.89-14.32), respectively, for death or intubation. These differences were significant only in the subgroup with low SpO2/FiO2.

CONCLUSIONS

Week-2-MP are effective in improving the prognosis of patients with COVID-19 pneumonia with features of inflammatory activity and respiratory deterioration entering the second week of disease. The recognition of this high-risk population should prompt early use of MP at this point.

DOI: 10.1371/journal.pone.0239401
PubMed: 32960899
PubMed Central: PMC7508405

Affiliations:

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Le document en format XML

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<author><name sortKey="Guio, Laura" sort="Guio, Laura" uniqKey="Guio L" first="Laura" last="Guio">Laura Guio</name>
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<author><name sortKey="Ibarrola, Marta" sort="Ibarrola, Marta" uniqKey="Ibarrola M" first="Marta" last="Ibarrola">Marta Ibarrola</name>
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<author><name sortKey="Martinez Berriotxoa, Agustin" sort="Martinez Berriotxoa, Agustin" uniqKey="Martinez Berriotxoa A" first="Agustin" last="Martinez-Berriotxoa">Agustin Martinez-Berriotxoa</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Second week methyl-prednisolone pulses improve prognosis in patients with severe coronavirus disease 2019 pneumonia: An observational comparative study using routine care data.</title>
<author><name sortKey="Ruiz Irastorza, Guillermo" sort="Ruiz Irastorza, Guillermo" uniqKey="Ruiz Irastorza G" first="Guillermo" last="Ruiz-Irastorza">Guillermo Ruiz-Irastorza</name>
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<author><name sortKey="Pijoan, Jose Ignacio" sort="Pijoan, Jose Ignacio" uniqKey="Pijoan J" first="Jose-Ignacio" last="Pijoan">Jose-Ignacio Pijoan</name>
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<author><name sortKey="Bereciartua, Elena" sort="Bereciartua, Elena" uniqKey="Bereciartua E" first="Elena" last="Bereciartua">Elena Bereciartua</name>
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<affiliation wicri:level="1"><nlm:affiliation>Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Dunder, Susanna" sort="Dunder, Susanna" uniqKey="Dunder S" first="Susanna" last="Dunder">Susanna Dunder</name>
<affiliation wicri:level="1"><nlm:affiliation>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Dominguez, Jokin" sort="Dominguez, Jokin" uniqKey="Dominguez J" first="Jokin" last="Dominguez">Jokin Dominguez</name>
<affiliation wicri:level="1"><nlm:affiliation>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Garcia Escudero, Paula" sort="Garcia Escudero, Paula" uniqKey="Garcia Escudero P" first="Paula" last="Garcia-Escudero">Paula Garcia-Escudero</name>
<affiliation wicri:level="3"><nlm:affiliation>CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER of Epidemiology and Public Health (CIBERESP), Madrid</wicri:regionArea>
<placeName><settlement type="city">Madrid</settlement>
<region nuts="2" type="region">Communauté de Madrid</region>
</placeName>
</affiliation>
<affiliation wicri:level="1"><nlm:affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Rodrigo, Alejandro" sort="Rodrigo, Alejandro" uniqKey="Rodrigo A" first="Alejandro" last="Rodrigo">Alejandro Rodrigo</name>
<affiliation wicri:level="1"><nlm:affiliation>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Gomez Carballo, Carlota" sort="Gomez Carballo, Carlota" uniqKey="Gomez Carballo C" first="Carlota" last="Gomez-Carballo">Carlota Gomez-Carballo</name>
<affiliation wicri:level="1"><nlm:affiliation>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Varona, Jimena" sort="Varona, Jimena" uniqKey="Varona J" first="Jimena" last="Varona">Jimena Varona</name>
<affiliation wicri:level="1"><nlm:affiliation>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Guio, Laura" sort="Guio, Laura" uniqKey="Guio L" first="Laura" last="Guio">Laura Guio</name>
<affiliation wicri:level="1"><nlm:affiliation>University of the Basque Country (UPV/EHU), Leioa, BI, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>University of the Basque Country (UPV/EHU), Leioa, BI</wicri:regionArea>
<wicri:noRegion>BI</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:affiliation>Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Ibarrola, Marta" sort="Ibarrola, Marta" uniqKey="Ibarrola M" first="Marta" last="Ibarrola">Marta Ibarrola</name>
<affiliation wicri:level="1"><nlm:affiliation>University of the Basque Country (UPV/EHU), Leioa, BI, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>University of the Basque Country (UPV/EHU), Leioa, BI</wicri:regionArea>
<wicri:noRegion>BI</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Ugarte, Amaia" sort="Ugarte, Amaia" uniqKey="Ugarte A" first="Amaia" last="Ugarte">Amaia Ugarte</name>
<affiliation wicri:level="1"><nlm:affiliation>Autoimmune Diseases Research Unit, Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Autoimmune Diseases Research Unit, Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Martinez Berriotxoa, Agustin" sort="Martinez Berriotxoa, Agustin" uniqKey="Martinez Berriotxoa A" first="Agustin" last="Martinez-Berriotxoa">Agustin Martinez-Berriotxoa</name>
<affiliation wicri:level="1"><nlm:affiliation>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:affiliation>Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia</wicri:regionArea>
<wicri:noRegion>Bizkaia</wicri:noRegion>
</affiliation>
</author>
</analytic>
<series><title level="j">PloS one</title>
<idno type="eISSN">1932-6203</idno>
<imprint><date when="2020" type="published">2020</date>
</imprint>
</series>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term>
<term>Coronavirus Infections (diagnosis)</term>
<term>Coronavirus Infections (pathology)</term>
<term>Female (MeSH)</term>
<term>Glucocorticoids (therapeutic use)</term>
<term>Humans (MeSH)</term>
<term>Inflammation (MeSH)</term>
<term>Intubation, Intratracheal (MeSH)</term>
<term>Male (MeSH)</term>
<term>Methylprednisolone (administration & dosage)</term>
<term>Methylprednisolone (pharmacology)</term>
<term>Methylprednisolone (therapeutic use)</term>
<term>Middle Aged (MeSH)</term>
<term>Oxygen (blood)</term>
<term>Pandemics (MeSH)</term>
<term>Pneumonia, Viral (diagnosis)</term>
<term>Pneumonia, Viral (pathology)</term>
<term>Prognosis (MeSH)</term>
<term>Retrospective Studies (MeSH)</term>
<term>Risk (MeSH)</term>
<term>Risk Factors (MeSH)</term>
<term>Spain (MeSH)</term>
<term>Time Factors (MeSH)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Adulte d'âge moyen (MeSH)</term>
<term>Espagne (MeSH)</term>
<term>Facteurs de risque (MeSH)</term>
<term>Facteurs temps (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Glucocorticoïdes (usage thérapeutique)</term>
<term>Humains (MeSH)</term>
<term>Infections à coronavirus (anatomopathologie)</term>
<term>Infections à coronavirus (diagnostic)</term>
<term>Inflammation (MeSH)</term>
<term>Intubation trachéale (MeSH)</term>
<term>Mâle (MeSH)</term>
<term>Méthylprednisolone (administration et posologie)</term>
<term>Méthylprednisolone (pharmacologie)</term>
<term>Méthylprednisolone (usage thérapeutique)</term>
<term>Oxygène (sang)</term>
<term>Pandémies (MeSH)</term>
<term>Pneumopathie virale (anatomopathologie)</term>
<term>Pneumopathie virale (diagnostic)</term>
<term>Pronostic (MeSH)</term>
<term>Risque (MeSH)</term>
<term>Sujet âgé (MeSH)</term>
<term>Études rétrospectives (MeSH)</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Methylprednisolone</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Oxygen</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="pharmacology" xml:lang="en"><term>Methylprednisolone</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Glucocorticoids</term>
<term>Methylprednisolone</term>
</keywords>
<keywords scheme="MESH" type="geographic" xml:lang="en"><term>Spain</term>
</keywords>
<keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Méthylprednisolone</term>
</keywords>
<keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Infections à coronavirus</term>
<term>Pneumopathie virale</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Infections à coronavirus</term>
<term>Pneumopathie virale</term>
</keywords>
<keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="pharmacologie" xml:lang="fr"><term>Méthylprednisolone</term>
</keywords>
<keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Oxygène</term>
</keywords>
<keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Glucocorticoïdes</term>
<term>Méthylprednisolone</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Aged</term>
<term>Female</term>
<term>Humans</term>
<term>Inflammation</term>
<term>Intubation, Intratracheal</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Pandemics</term>
<term>Prognosis</term>
<term>Retrospective Studies</term>
<term>Risk</term>
<term>Risk Factors</term>
<term>Time Factors</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Adulte d'âge moyen</term>
<term>Espagne</term>
<term>Facteurs de risque</term>
<term>Facteurs temps</term>
<term>Femelle</term>
<term>Humains</term>
<term>Inflammation</term>
<term>Intubation trachéale</term>
<term>Mâle</term>
<term>Pandémies</term>
<term>Pronostic</term>
<term>Risque</term>
<term>Sujet âgé</term>
<term>Études rétrospectives</term>
</keywords>
<keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Espagne</term>
</keywords>
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<front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b>
</p>
<p>To analyze the effects of a short course of methyl-prednisolone pulses (MP) during the second week of disease (week-2) in patients with severe coronavirus disease 2019 (COVID-19) pneumonia.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>Comparative observational study using data collected from routine care at Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain in patients with COVID-19 pneumonia. We compared patients who received week-2-MP (125-250 mg/d x3) with those who did not, with the end-points time to death and time to death or endotracheal intubation.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>We included 242 patients with COVID-19 pneumonia and elevated inflammatory markers at admission. Sixty-one patients (25%) received week-2-MP. Twenty-two patients (9%) died and 31 (12.8%) suffered death or intubation. The adjusted HRs for death and death or intubation for patients in the week-2-MP group were 0.35 (95%CI 0.11 to 1.06, p = 0.064) and 0.33 (95%CI 0.13 to 0.84, p = 0.020), respectively. These differences were specifically seen in the subcohort of patients with a SpO2/FiO2 at day 7 lower than 353 (adjusted HR 0.31, 95% CI 0.08 to 1.12, p = 0.073 and HR 0.34, 95%CI 0.12 to 0.94, p = 0.038, respectively) but not in patients with higher SpO2/FiO2. Patients receiving out-of-week-2-MP, non-pulse glucocorticoids or no glucocorticoids had an increased adjusted risk for both outcomes compared with week-2-MP group: HR 5.04 (95% CI 0.91-27.86), HR 10.09 (95% CI 2.14-47.50), HR 4.14 (95% CI 0.81-21.23), respectively, for death; HR 7.38 (95% CI 1.86-29.29), HR 13.71 (95% CI 3.76-50.07), HR 3.58 (95% CI 0.89-14.32), respectively, for death or intubation. These differences were significant only in the subgroup with low SpO2/FiO2.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b>
</p>
<p>Week-2-MP are effective in improving the prognosis of patients with COVID-19 pneumonia with features of inflammatory activity and respiratory deterioration entering the second week of disease. The recognition of this high-risk population should prompt early use of MP at this point.</p>
</div>
</front>
</TEI>
<pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32960899</PMID>
<DateCompleted><Year>2020</Year>
<Month>10</Month>
<Day>13</Day>
</DateCompleted>
<DateRevised><Year>2020</Year>
<Month>10</Month>
<Day>13</Day>
</DateRevised>
<Article PubModel="Electronic-eCollection"><Journal><ISSN IssnType="Electronic">1932-6203</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>15</Volume>
<Issue>9</Issue>
<PubDate><Year>2020</Year>
</PubDate>
</JournalIssue>
<Title>PloS one</Title>
<ISOAbbreviation>PLoS One</ISOAbbreviation>
</Journal>
<ArticleTitle>Second week methyl-prednisolone pulses improve prognosis in patients with severe coronavirus disease 2019 pneumonia: An observational comparative study using routine care data.</ArticleTitle>
<Pagination><MedlinePgn>e0239401</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1371/journal.pone.0239401</ELocationID>
<Abstract><AbstractText Label="OBJECTIVE">To analyze the effects of a short course of methyl-prednisolone pulses (MP) during the second week of disease (week-2) in patients with severe coronavirus disease 2019 (COVID-19) pneumonia.</AbstractText>
<AbstractText Label="METHODS">Comparative observational study using data collected from routine care at Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain in patients with COVID-19 pneumonia. We compared patients who received week-2-MP (125-250 mg/d x3) with those who did not, with the end-points time to death and time to death or endotracheal intubation.</AbstractText>
<AbstractText Label="RESULTS">We included 242 patients with COVID-19 pneumonia and elevated inflammatory markers at admission. Sixty-one patients (25%) received week-2-MP. Twenty-two patients (9%) died and 31 (12.8%) suffered death or intubation. The adjusted HRs for death and death or intubation for patients in the week-2-MP group were 0.35 (95%CI 0.11 to 1.06, p = 0.064) and 0.33 (95%CI 0.13 to 0.84, p = 0.020), respectively. These differences were specifically seen in the subcohort of patients with a SpO2/FiO2 at day 7 lower than 353 (adjusted HR 0.31, 95% CI 0.08 to 1.12, p = 0.073 and HR 0.34, 95%CI 0.12 to 0.94, p = 0.038, respectively) but not in patients with higher SpO2/FiO2. Patients receiving out-of-week-2-MP, non-pulse glucocorticoids or no glucocorticoids had an increased adjusted risk for both outcomes compared with week-2-MP group: HR 5.04 (95% CI 0.91-27.86), HR 10.09 (95% CI 2.14-47.50), HR 4.14 (95% CI 0.81-21.23), respectively, for death; HR 7.38 (95% CI 1.86-29.29), HR 13.71 (95% CI 3.76-50.07), HR 3.58 (95% CI 0.89-14.32), respectively, for death or intubation. These differences were significant only in the subgroup with low SpO2/FiO2.</AbstractText>
<AbstractText Label="CONCLUSIONS">Week-2-MP are effective in improving the prognosis of patients with COVID-19 pneumonia with features of inflammatory activity and respiratory deterioration entering the second week of disease. The recognition of this high-risk population should prompt early use of MP at this point.</AbstractText>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Ruiz-Irastorza</LastName>
<ForeName>Guillermo</ForeName>
<Initials>G</Initials>
<Identifier Source="ORCID">0000-0001-7788-1043</Identifier>
<AffiliationInfo><Affiliation>Autoimmune Diseases Research Unit, Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Pijoan</LastName>
<ForeName>Jose-Ignacio</ForeName>
<Initials>JI</Initials>
<AffiliationInfo><Affiliation>Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Service of Rheumatology, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Bereciartua</LastName>
<ForeName>Elena</ForeName>
<Initials>E</Initials>
<AffiliationInfo><Affiliation>University of the Basque Country (UPV/EHU), Leioa, BI, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Dunder</LastName>
<ForeName>Susanna</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Dominguez</LastName>
<ForeName>Jokin</ForeName>
<Initials>J</Initials>
<Identifier Source="ORCID">0000-0002-7943-1887</Identifier>
<AffiliationInfo><Affiliation>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Garcia-Escudero</LastName>
<ForeName>Paula</ForeName>
<Initials>P</Initials>
<AffiliationInfo><Affiliation>CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Rodrigo</LastName>
<ForeName>Alejandro</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Gomez-Carballo</LastName>
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</AffiliationInfo>
<AffiliationInfo><Affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
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<ForeName>Jimena</ForeName>
<Initials>J</Initials>
<AffiliationInfo><Affiliation>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
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<Initials>L</Initials>
<AffiliationInfo><Affiliation>University of the Basque Country (UPV/EHU), Leioa, BI, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
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<Initials>M</Initials>
<AffiliationInfo><Affiliation>University of the Basque Country (UPV/EHU), Leioa, BI, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
</Author>
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<ForeName>Amaia</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Autoimmune Diseases Research Unit, Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Martinez-Berriotxoa</LastName>
<ForeName>Agustin</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><CollectiveName>Cruces COVID Study Group</CollectiveName>
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<Language>eng</Language>
<PublicationTypeList><PublicationType UI="D003160">Comparative Study</PublicationType>
<PublicationType UI="D016428">Journal Article</PublicationType>
<PublicationType UI="D064888">Observational Study</PublicationType>
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<Month>09</Month>
<Day>22</Day>
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<MedlineTA>PLoS One</MedlineTA>
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<MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName>
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</MeshHeading>
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<MeshHeading><DescriptorName UI="D013030" MajorTopicYN="N" Type="Geographic">Spain</DescriptorName>
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<CoiStatement>The authors have declared that no competing interests exist.</CoiStatement>
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<Month>07</Month>
<Day>30</Day>
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<PubMedPubDate PubStatus="accepted"><Year>2020</Year>
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<ReferenceList><Reference><Citation>Eur Radiol. 2020 Aug;30(8):4417-4426</Citation>
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</Reference>
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</Reference>
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<Reference><Citation>JAMA Intern Med. 2020 Jul 1;180(7):934-943</Citation>
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<Reference><Citation>N Engl J Med. 2020 Jul 17;:</Citation>
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<affiliations><list><country><li>Espagne</li>
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<region><li>Communauté de Madrid</li>
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<settlement><li>Madrid</li>
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<tree><country name="Espagne"><noRegion><name sortKey="Ruiz Irastorza, Guillermo" sort="Ruiz Irastorza, Guillermo" uniqKey="Ruiz Irastorza G" first="Guillermo" last="Ruiz-Irastorza">Guillermo Ruiz-Irastorza</name>
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<name sortKey="Dunder, Susanna" sort="Dunder, Susanna" uniqKey="Dunder S" first="Susanna" last="Dunder">Susanna Dunder</name>
<name sortKey="Garcia Escudero, Paula" sort="Garcia Escudero, Paula" uniqKey="Garcia Escudero P" first="Paula" last="Garcia-Escudero">Paula Garcia-Escudero</name>
<name sortKey="Garcia Escudero, Paula" sort="Garcia Escudero, Paula" uniqKey="Garcia Escudero P" first="Paula" last="Garcia-Escudero">Paula Garcia-Escudero</name>
<name sortKey="Gomez Carballo, Carlota" sort="Gomez Carballo, Carlota" uniqKey="Gomez Carballo C" first="Carlota" last="Gomez-Carballo">Carlota Gomez-Carballo</name>
<name sortKey="Gomez Carballo, Carlota" sort="Gomez Carballo, Carlota" uniqKey="Gomez Carballo C" first="Carlota" last="Gomez-Carballo">Carlota Gomez-Carballo</name>
<name sortKey="Guio, Laura" sort="Guio, Laura" uniqKey="Guio L" first="Laura" last="Guio">Laura Guio</name>
<name sortKey="Guio, Laura" sort="Guio, Laura" uniqKey="Guio L" first="Laura" last="Guio">Laura Guio</name>
<name sortKey="Guio, Laura" sort="Guio, Laura" uniqKey="Guio L" first="Laura" last="Guio">Laura Guio</name>
<name sortKey="Ibarrola, Marta" sort="Ibarrola, Marta" uniqKey="Ibarrola M" first="Marta" last="Ibarrola">Marta Ibarrola</name>
<name sortKey="Ibarrola, Marta" sort="Ibarrola, Marta" uniqKey="Ibarrola M" first="Marta" last="Ibarrola">Marta Ibarrola</name>
<name sortKey="Martinez Berriotxoa, Agustin" sort="Martinez Berriotxoa, Agustin" uniqKey="Martinez Berriotxoa A" first="Agustin" last="Martinez-Berriotxoa">Agustin Martinez-Berriotxoa</name>
<name sortKey="Martinez Berriotxoa, Agustin" sort="Martinez Berriotxoa, Agustin" uniqKey="Martinez Berriotxoa A" first="Agustin" last="Martinez-Berriotxoa">Agustin Martinez-Berriotxoa</name>
<name sortKey="Martinez Berriotxoa, Agustin" sort="Martinez Berriotxoa, Agustin" uniqKey="Martinez Berriotxoa A" first="Agustin" last="Martinez-Berriotxoa">Agustin Martinez-Berriotxoa</name>
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<name sortKey="Pijoan, Jose Ignacio" sort="Pijoan, Jose Ignacio" uniqKey="Pijoan J" first="Jose-Ignacio" last="Pijoan">Jose-Ignacio Pijoan</name>
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<name sortKey="Ruiz Irastorza, Guillermo" sort="Ruiz Irastorza, Guillermo" uniqKey="Ruiz Irastorza G" first="Guillermo" last="Ruiz-Irastorza">Guillermo Ruiz-Irastorza</name>
<name sortKey="Ugarte, Amaia" sort="Ugarte, Amaia" uniqKey="Ugarte A" first="Amaia" last="Ugarte">Amaia Ugarte</name>
<name sortKey="Ugarte, Amaia" sort="Ugarte, Amaia" uniqKey="Ugarte A" first="Amaia" last="Ugarte">Amaia Ugarte</name>
<name sortKey="Varona, Jimena" sort="Varona, Jimena" uniqKey="Varona J" first="Jimena" last="Varona">Jimena Varona</name>
<name sortKey="Varona, Jimena" sort="Varona, Jimena" uniqKey="Varona J" first="Jimena" last="Varona">Jimena Varona</name>
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   |texte=   Second week methyl-prednisolone pulses improve prognosis in patients with severe coronavirus disease 2019 pneumonia: An observational comparative study using routine care data.
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Second week methyl-prednisolone pulses improve prognosis in patients with severe coronavirus disease 2019 pneumonia: An observational comparative study using routine care data.

Second week methyl-prednisolone pulses improve prognosis in patients with severe coronavirus disease 2019 pneumonia: An observational comparative study using routine care data.

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