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10.1172/JCI140617 http://scihub22266oqcxt.onion/10.1172/JCI140617 33141117!7685724!33141117     free     free     free       J+Clin+Invest 2020 ; 130 (12): 6417-6428 Nephropedia Template TP {{tp|p=33141117|t=2020. Corticosteroid treatment in severe COVID-19 patients with acute respiratory distress syndrome |pdf=|usr=}}{{33141117}} gab.com Text Corticosteroid treatment in severe COVID-19 patients with acute respiratory distress syndrome JO: J Clin Invest http://www.kidney.de/pget.php?&tw=1&pmid=33141117 #FOAvip BACKGROUNDCorticosteroids are widely used in patients with COVID 19, although their benefit-to-risk ratio remains controversial.METHODSPatients with severe COVID-19-related acute respiratory distress syndrome (ARDS) were included from December 29, 2019 to March 16, 2020 in 5 tertiary Chinese hospitals. Cox proportional hazards and competing risks analyses were conducted to analyze the impact of corticosteroids on mortality and SARS-CoV-2 RNA clearance, respectively. We performed a propensity score (PS) matching analysis to control confounding factors.RESULTSOf 774 eligible patients, 409 patients received corticosteroids, with a median time from hospitalization to starting corticosteroids of 1.0 day (IQR 0.0-3.0 days) . As compared with usual care, treatment with corticosteroids was associated with increased rate of myocardial (15.6% vs. 10.4%, P = 0.041) and liver injury (18.3% vs. 9.9%, P = 0.001), of shock (22.0% vs. 12.6%, P < 0.001), of need for mechanical ventilation (38.1% vs. 19.5%, P < 0.001), and increased rate of 28-day all-cause mortality (44.3% vs. 31.0%, P < 0.001). After PS matching, corticosteroid therapy was associated with 28-day mortality (adjusted HR 1.46, 95% CI 1.01-2.13, P = 0.045). High dose (>200 mg) and early initiation (</=3 days from hospitalization) of corticosteroid therapy were associated with a higher 28-day mortality rate. Corticosteroid use was also associated with a delay in SARS-CoV-2 coronavirus RNA clearance in the competing risk analysis (subhazard ratio 1.59, 95% CI 1.17-2.15, P = 0.003).CONCLUSIONAdministration of corticosteroids in severe COVID-19-related ARDS is associated with increased 28-day mortality and delayed SARS-CoV-2 coronavirus RNA clearance after adjustment for time-varying confounders.FUNDINGNone. Twit Text FOAVip Corticosteroid treatment in severe COVID-19 patients with acute respiratory distress syndrome ????J Clin Invest http://www.kidney.de/pget.php?&tw=1&pmid=33141117 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=33141117 #FOAvip English Wikipedia <ref>{{Cite pmid|33141117}}</ref> Corticosteroid treatment in severe COVID-19 patients with acute respiratory distress syndrome #MMPMID33141117 Liu J; Zhang S; Dong X; Li Z; Xu Q; Feng H; Cai J; Huang S; Guo J; Zhang L; Chen Y; Zhu W; Du H; Liu Y; Wang T; Chen L; Wen Z; Annane D; Qu J; Chen D J Clin Invest 2020[Dec]; 130 (12): 6417-6428 PMID33141117show ga BACKGROUNDCorticosteroids are widely used in patients with COVID 19, although their benefit-to-risk ratio remains controversial.METHODSPatients with severe COVID-19-related acute respiratory distress syndrome (ARDS) were included from December 29, 2019 to March 16, 2020 in 5 tertiary Chinese hospitals. Cox proportional hazards and competing risks analyses were conducted to analyze the impact of corticosteroids on mortality and SARS-CoV-2 RNA clearance, respectively. We performed a propensity score (PS) matching analysis to control confounding factors.RESULTSOf 774 eligible patients, 409 patients received corticosteroids, with a median time from hospitalization to starting corticosteroids of 1.0 day (IQR 0.0-3.0 days) . As compared with usual care, treatment with corticosteroids was associated with increased rate of myocardial (15.6% vs. 10.4%, P = 0.041) and liver injury (18.3% vs. 9.9%, P = 0.001), of shock (22.0% vs. 12.6%, P < 0.001), of need for mechanical ventilation (38.1% vs. 19.5%, P < 0.001), and increased rate of 28-day all-cause mortality (44.3% vs. 31.0%, P < 0.001). After PS matching, corticosteroid therapy was associated with 28-day mortality (adjusted HR 1.46, 95% CI 1.01-2.13, P = 0.045). High dose (>200 mg) and early initiation ( |*COVID-19 Drug Treatment[MESH] |Adrenal Cortex Hormones/*administration & dosage/*adverse effects[MESH] |Aged[MESH] |COVID-19/complications/*mortality[MESH] |Disease-Free Survival[MESH] |Female[MESH] |Humans[MESH] |Male[MESH] |Middle Aged[MESH] |Respiratory Distress Syndrome/*drug therapy/etiology/*mortality[MESH] |Retrospective Studies[MESH] |Severity of Illness Index[MESH]Corticosteroid treatment in severe COVID-19 patients with acute respir(epmc).pdf DeepDyve Pubget Overpricing