KCI등재
SCI
SCIE
SCOPUS
A Comparison of the Effects of Dexamethasone and Methylprednisolone, Used on Level-3 Intensive Care COVID-19 Patients, on Mortality: A Multi-Center Retrospective Study
저자
Sari Ahmet (Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.) ; Ekinci Osman (Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.) ; Saraçoğlu Kemal Tolga (Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Kartal Dr. Lutfi Kırdar Training and Research Hospital, Istanbul, Turkey.) ; Balık Recep (Department of İnfectious Diseases and Clinical Microbiology, Health Sciences University Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.) ; Aslan Mesut (Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.) ; Balık Yelda (Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.) ; Önal Ceren (Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Kartal Dr. Lutfi Kırdar Training and Research Hospital, Istanbul, Turkey.) ; Aslan Murat (Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.) ; Cevher Semra (Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.) ; Parmaksız Aylin (Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.) ; Vatansever Şule (Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul, Turkey.) ; Çicek Münire Canan (Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul, Turkey.) ; Ayan Özge Sayın (Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul, Turkey.) ; Şensöz Çelik Gaye (Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul, Turkey.) ; Toprak Açelya (Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul, Turkey.) ; Yılmaz Mehmet (Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Derince Training and Research Hospital, Kocaeli, Turkey.) ; Yurt Emine (Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Derince Training and Research Hospital, Kocaeli, Turkey.) ; Bakan Nurten (Department of Anesthesiology and Reanimation/Intensive Care, Sancaktepe Şehit Prof Dr Ilhan Varank Training and Research Hospital, İstanbul, Turkey.) ; Tekin Selda (Department of Anesthesiology and Reanimation/Intensive Care, Sancaktepe Şehit Prof Dr Ilhan Varank Training and Research Hospital, İstanbul, Turkey.) ; Adıyeke Esra (Department of Anesthesiology and Reanimation/Intensive Care, Sancaktepe Şehit Prof Dr Ilhan Varank Training and Research Hospital, İstanbul, Turkey.)
발행기관
학술지명
Journal of Korean medical science(Journal of Korean Medical Science)
권호사항
발행연도
2023
작성언어
English
주제어
등재정보
KCI등재,SCI,SCIE,SCOPUS
자료형태
학술저널
수록면
1-13(13쪽)
DOI식별코드
제공처
Background: Coronavirus disease 2019 (COVID-19) is often a mild disease, usually manifesting with respiratory complaints, and is sometimes mortal due to multiple organ failure. Hyperinflammation is a known COVID-19 component and is associated with organ dysfunction, disease severity and mortality. Controlling hyperinflammatory response is crucial in determining treatment direction. An important agent in providing this control is corticosteroids. This study aimed to determine whether dexamethasone and methylprednisolone, doses, administration time and duration in COVID-19 treatment are associated with improved treatment outcomes.
Methods: This retrospective multicenter study was conducted with participation of 6 healthcare centers which collected data by retrospectively examining files of 1,340 patients admitted to intensive care unit due to COVID-19 between March 2020 and September 2021, diagnosed with polymerase chain reaction (+) and/or clinically and radiologically.
Results: Mortality in the pulse methylprednisolone group was statistically significantly higher than that in the other 3 groups. Mortality was higher in older patients with comorbidities such as hypertension, diabetes mellitus, chronic kidney failure, coronary artery disease, and dementia. Pulse and mini-pulse steroid doses were less effective than standard methylprednisolone and dexamethasone doses, pulse steroid doses being associated with high mortality. Standard-dose methylprednisolone and dexamethasone led to similar effects, but standard dose methylprednisolone was more effective in severe patients who required mechanical ventilation (MV). Infection development was related to steroid treatment duration, not cumulative steroid dose.
Conclusion: Corticosteroids are shown to be beneficial in critical COVID-19, but the role of early corticosteroids in mild COVID-19 patients remains unclear. The anti-inflammatory effects of corticosteroids may have a positive effect by reducing mortality in severe COVID-19 patients. Although dexamethasone was first used for this purpose, methylprednisolone was found to be as effective at standard doses. Methylprednisolone administered at standard doses was associated with greater PaO2/FiO2 ratios than dexamethasone, especially in the severe group requiring MV. High dose pulse steroid doses are closely associated with mortality and standard methylprednisolone dose is recommended.
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