Dataset Information

Determinants of the protective effect of glucocorticoids on mortality in hospitalized patients with COVID-19: Insights from the Cardio-COVID-Italy multicenter study.

ABSTRACT:

Background

Glucocorticoid therapy has emerged as an effective therapeutic option in hospitalized patients with coronavirus disease 2019 (COVID-19). This study aimed to focus on the impact of relevant clinical and laboratory factors on the protective effect of glucocorticoids on mortality.

Methods

A sub-analysis was performed of the multicenter Cardio-COVID-Italy registry, enrolling consecutive patients with COVID-19 admitted to 13 Italian cardiology units between 01 March 2020 and 09 April 2020. The primary endpoint was in-hospital mortality.

Results

A total of 706 COVID-19 patients were included (349 treated with glucocorticoids, 357 not treated with glucocorticoids). After adjustment for relevant covariates, use of glucocorticoids was associated with a lower risk of in-hospital mortality (adjusted HR 0.44; 95% CI 0.26-0.72; p = 0.001). A significant interaction was observed between the protective effect of glucocorticoids on mortality and PaO₂/FiO₂ ratio on admission (p = 0.042), oxygen saturation on admission (p = 0.017), and peak CRP (0.023). Such protective effects of glucocorticoids were mainly observed in patients with lower PaO₂/FiO₂ ratio (<300), lower oxygen saturation (<90%), and higher CRP (>100 mg/L).

Conclusions

The protective effects of glucocorticoids on mortality in COVID-19 were more evident among patients with worse respiratory parameters and higher systemic inflammation.

SUBMITTER: Pagnesi M

PROVIDER: S-EPMC8159705 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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Publications

Determinants of the protective effect of glucocorticoids on mortality in hospitalized patients with COVID-19: Insights from the Cardio-COVID-Italy multicenter study.

Pagnesi Matteo M Inciardi Riccardo M RM Lombardi Carlo M CM Agostoni Piergiuseppe P Ameri Pietro P Barbieri Lucia L Bellasi Antonio A Camporotondo Rita R Canale Claudia C Carubelli Valentina V Carugo Stefano S Catagnano Francesco F Dalla Vecchia Laura A LA Danzi Gian Battista GB Di Pasquale Mattia M Gaudenzi Margherita M Giovinazzo Stefano S Gnecchi Massimiliano M Guazzi Marco M Iorio Annamaria A La Rovere Maria Teresa MT Leonardi Sergio S Maccagni Gloria G Mapelli Massimo M Margonato Davide D Merlo Marco M Monzo Luca L Mortara Andrea A Nuzzi Vincenzo V Piepoli Massimo M Porto Italo I Pozzi Andrea A Sarullo Filippo F Sinagra Gianfranco G Tedino Chiara C Tomasoni Daniela D Volterrani Maurizio M Zaccone Gregorio G Senni Michele M Metra Marco M

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 20210528

<h4>Background</h4>Glucocorticoid therapy has emerged as an effective therapeutic option in hospitalized patients with coronavirus disease 2019 (COVID-19). This study aimed to focus on the impact of relevant clinical and laboratory factors on the protective effect of glucocorticoids on mortality.<h4>Methods</h4>A sub-analysis was performed of the multicenter Cardio-COVID-Italy registry, enrolling consecutive patients with COVID-19 admitted to 13 Italian cardiology units between 01 March 2020 and ...[more]

PMID: 34052406

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Project description:ImportanceIt is not well understood if and how various social and environmental determinants of health (SEDoH) are associated with mortality rates related to cardio-kidney-metabolic syndrome (CKM) across the US.ObjectiveTo study the magnitude of the association strength of SEDoH with CKM-related mortality at the county level across the US.Design, setting, and participantsThis cross-sectional, retrospective, population-based study used aggregate county-level data from the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) data portal from 2010-2019. Data analysis occurred from September 2023 to January 2024.ExposuresA total of 7 diverse SEDoH were chosen, including median annual household income, percentage of racial and ethnic minority residents per county, fine particulate air pollution (PM2.5) concentrations, high-school completion rate, primary health care access, food insecurity, and rurality rate.Main outcomes and measuresThe primary outcome was county-level age-adjusted mortality rate (aaMR) attributable to CKM. The association of county-level CKM-related aaMR with the 7 SEDoH was analyzed using geographically weighted models and the model median coefficients for each covariate studied.ResultsData from 3101 of 3243 counties (95.6%) were analyzed. There was substantial variation in SEDoH between states and counties. The overall pooled median (IQR) aaMR (2010-2019) in the US was 505.5 (441.3-578.9) per 100 000 residents. Most counties in the lower half of the US had rates much higher than the pooled median (eg, Southern US median [IQR] aaMR, 537.3 [466.0-615.9] per 100 000 residents). CKM-related mortality was positively associated with the food insecurity rate (median [IQR] β = 6.78 [2.78-11.56]) and PM2.5 concentrations (median [IQR] β = 5.52 [-11.06 to 19.70]), while it was negatively associated with median annual household income (median [IQR] β = -0.002 [-0.003 to -0.001]), rurality (median [IQR] β = -0.32 [-0.67 to 0.02]), high school completion rate (median [IQR] β = -1.89 [-4.54 to 0.10]), racial and ethnic minority rate (median [IQR] β = -0.66 [-1.85 to 0.89]), and primary health care access rate (median [IQR] β = -0.18 [-0.35 to 0.07]).Conclusions and relevanceIn this cross-sectional study of county-level data across the US, there were substantial geographical differences in the magnitude of the association of SEDoH with CKM-related aaMR. These findings may provide guidance for deciding local health care policy.

Dataset Information

Determinants of the protective effect of glucocorticoids on mortality in hospitalized patients with COVID-19: Insights from the Cardio-COVID-Italy multicenter study.

Background

Methods

Results

Conclusions

Publications

Determinants of the protective effect of glucocorticoids on mortality in hospitalized patients with COVID-19: Insights from the Cardio-COVID-Italy multicenter study.

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