Methylprednisolone and 60 Days in Hospital Survival in Coronavirus Disease 2019 Pneumonia

Ronaldo C. Go, MD; Roshan Shah, MD; Themba Nyirenda, PHD; Yukiko Oe, MD; Khurram Sarfraz, MD; Justin J. Panthappattu, MD; Lesley Philip, MD; Chandni Bheeman, DO; Neel Shah, DO; Sapan Shah, MD; Sophia Dar, MD; Sung Hung, MD; Waqas Rahman, MD; Hyun Im, MD; Michael Marafelias; Karan Omidvari, MD; Anuja Pradhan, MD; Sean Sadikot, MD; Keith M. Rose, MD; Steven J. Sperber, MD; Joshua Josephs, MD

doi:10.1097/CCE.0000000000000493

Critical Care Explorations (Jul 2021)

Methylprednisolone and 60 Days in Hospital Survival in Coronavirus Disease 2019 Pneumonia

Ronaldo C. Go, MD,
Roshan Shah, MD,
Themba Nyirenda, PHD,
Yukiko Oe, MD,
Khurram Sarfraz, MD,
Justin J. Panthappattu, MD,
Lesley Philip, MD,
Chandni Bheeman, DO,
Neel Shah, DO,
Sapan Shah, MD,
Sophia Dar, MD,
Sung Hung, MD,
Waqas Rahman, MD,
Hyun Im, MD,
Michael Marafelias,
Karan Omidvari, MD,
Anuja Pradhan, MD,
Sean Sadikot, MD,
Keith M. Rose, MD,
Steven J. Sperber, MD,
Joshua Josephs, MD

Affiliations

Ronaldo C. Go, MD: 1 Hackensack Meridian School of Medicine, Nutley, NJ.
Roshan Shah, MD: 3 Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.
Themba Nyirenda, PHD: 1 Hackensack Meridian School of Medicine, Nutley, NJ.
Yukiko Oe, MD: 5 Division of Pulmonary, Critical Care, Allergy and Rheumatology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ.
Khurram Sarfraz, MD: 3 Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.
Justin J. Panthappattu, MD: 3 Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.
Lesley Philip, MD: 3 Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.
Chandni Bheeman, DO: 3 Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.
Neel Shah, DO: 3 Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.
Sapan Shah, MD: 3 Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.
Sophia Dar, MD: 3 Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.
Sung Hung, MD: 3 Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.
Waqas Rahman, MD: 3 Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.
Hyun Im, MD: 3 Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ.
Michael Marafelias: 6 JTCC Applications, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ.
Karan Omidvari, MD: 1 Hackensack Meridian School of Medicine, Nutley, NJ.
Anuja Pradhan, MD: 1 Hackensack Meridian School of Medicine, Nutley, NJ.
Sean Sadikot, MD: 1 Hackensack Meridian School of Medicine, Nutley, NJ.
Keith M. Rose, MD: 1 Hackensack Meridian School of Medicine, Nutley, NJ.
Steven J. Sperber, MD: 1 Hackensack Meridian School of Medicine, Nutley, NJ.
Joshua Josephs, MD: 1 Hackensack Meridian School of Medicine, Nutley, NJ.

DOI: https://doi.org/10.1097/CCE.0000000000000493
Journal volume & issue: Vol. 3, no. 7
p. e0493

Abstract

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OBJECTIVES:. To determine methylprednisolone’s dose, duration, and administration from onset of symptoms and association with 60 days in hospital survival of coronavirus disease 2019 pneumonia. DESIGN:. Cohort study. SETTING:. Thirteen hospitals in New Jersey, United States during March to June 2020. PATIENTS:. Seven-hundred fifty-nine hospitalized coronavirus disease 2019 patients. INTERVENTIONS:. We performed a propensity matched cohort study between patients who received methylprednisolone and no methylprednisolone. Patients in the methylprednisolone group were further differentiated into dose (high dose and low dose), duration, and administration from onset of symptoms. MEASUREMENTS AND MAIN RESULTS:. In the propensity matched sample, 99 out of 380 (26%) in no methylprednisolone, 69 out of 215 (31.9%) in low-dose methylprednisolone, and 74 out of 164 (55.2%) high-dose methylprednisolone expired. Overall median survival for no methylprednisolone (25.0 d), low-dose methylprednisolone (39.0 d), high-dose methylprednisolone (20.0 d), less than or equal to 7 days duration (19.0 d), 7–14 days duration (30.0 d), greater than 14 days duration (44.0 d), onset of symptoms less than or equal to 7 days (20.0 d), and onset of symptoms 7–14 days (27.0 d) were statistically significant (log-rank p ≤ 0.001). Multivariate Cox regression showed nursing home residents, coronary artery disease, and invasive mechanical ventilation were independently associated with mortality. Methylprednisolone was associated with reduced mortality compared with no methylprednisolone (hazard ratio, 0.40; 95% CI, 0.27–0.59; p < 0.001) but no added benefit with high dose. Low-dose methylprednisolone for 7–14 days was associated with reduced mortality compared with less than or equal to 7 days (hazard ratio, 0.45; 95% CI, 0.22–0.91; p = 0.0273), and no additional benefit if greater than 14 days (hazard ratio, 1.27; 95% CI, 0.60–2.69; p = 0.5434). Combination therapy with tocilizumab was associated with reduced mortality over monotherapy (p < 0.0116). CONCLUSIONS:. Low-dose methylprednisolone was associated with reduced mortality if given greater than 7 days from onset of symptoms, and no additional benefit greater than 14 days. High dose was associated with higher mortality.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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