International Journal of Infectious Diseases (Jul 2021)
Determinants of the protective effect of glucocorticoids on mortality in hospitalized patients with COVID-19
- Matteo Pagnesi,
- Riccardo M. Inciardi,
- Carlo M. Lombardi,
- Piergiuseppe Agostoni,
- Pietro Ameri,
- Lucia Barbieri,
- Antonio Bellasi,
- Rita Camporotondo,
- Claudia Canale,
- Valentina Carubelli,
- Stefano Carugo,
- Francesco Catagnano,
- Laura A. Dalla Vecchia,
- Gian Battista Danzi,
- Mattia Di Pasquale,
- Margherita Gaudenzi,
- Stefano Giovinazzo,
- Massimiliano Gnecchi,
- Marco Guazzi,
- Annamaria Iorio,
- Maria Teresa La Rovere,
- Sergio Leonardi,
- Gloria Maccagni,
- Massimo Mapelli,
- Davide Margonato,
- Marco Merlo,
- Luca Monzo,
- Andrea Mortara,
- Vincenzo Nuzzi,
- Massimo Piepoli,
- Italo Porto,
- Andrea Pozzi,
- Filippo Sarullo,
- Gianfranco Sinagra,
- Chiara Tedino,
- Daniela Tomasoni,
- Maurizio Volterrani,
- Gregorio Zaccone,
- Michele Senni,
- Marco Metra
Affiliations
- Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Riccardo M. Inciardi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Carlo M. Lombardi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Pietro Ameri
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy
- Lucia Barbieri
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
- Antonio Bellasi
- Innovation and Brand Reputation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Rita Camporotondo
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
- Claudia Canale
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy
- Valentina Carubelli
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Stefano Carugo
- Division of Cardiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
- Francesco Catagnano
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy; Cardiology Department, Policlinico di Monza, Monza, Italy
- Laura A. Dalla Vecchia
- Cardiology Department, IRCCS Istituti Clinici Scientifici Maugeri, Istituto Scientifico di Milano, Milan, Italy
- Gian Battista Danzi
- Division of Cardiology, Ospedale Maggiore di Cremona, Cremona, Italy
- Mattia Di Pasquale
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Margherita Gaudenzi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Stefano Giovinazzo
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy
- Massimiliano Gnecchi
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
- Marco Guazzi
- Heart Failure Unit, Cardiology Department, University of Milan, Milan, Italy; IRCCS San Donato Hospital, Milan, Italy
- Annamaria Iorio
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Maria Teresa La Rovere
- Cardiology Department, IRCCS Istituti Clinici Scientifici Maugeri, Istituto Scientifico di Pavia, Pavia, Italy
- Sergio Leonardi
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
- Gloria Maccagni
- Division of Cardiology, Ospedale Maggiore di Cremona, Cremona, Italy
- Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Davide Margonato
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy; Cardiology Department, Policlinico di Monza, Monza, Italy
- Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
- Luca Monzo
- Istituto Clinico Casalpalocco and Policlinico Casilino, Rome, Italy
- Andrea Mortara
- Cardiology Department, Policlinico di Monza, Monza, Italy
- Vincenzo Nuzzi
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
- Massimo Piepoli
- Heart Failure Unit, Guglielmo da Saliceto Hospital, AUSL Piacenza, Piacenza, Italy; Institute of Life Sciences, Sant’Anna School of Advanced Studies, Pisa, Italy
- Italo Porto
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy
- Andrea Pozzi
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Filippo Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
- Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
- Chiara Tedino
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Maurizio Volterrani
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
- Gregorio Zaccone
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Michele Senni
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Corresponding author at: Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
- Journal volume & issue
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Vol. 108
pp. 270 – 273
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 (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.
