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Some thoughts about steroids for #COVID19
Based on studies w/ flu, MERS-CoV, & SARS, steroids did not show any benefit
In fact, steroids were associated w/ delayed viral clearance of MERS-CoV & SARS, in addition to complications- DM, psychosis, & AVN
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30317-2/fulltext">https://www.thelancet.com/journals/...
Some thoughts about steroids for #COVID19
Based on studies w/ flu, MERS-CoV, & SARS, steroids did not show any benefit
In fact, steroids were associated w/ delayed viral clearance of MERS-CoV & SARS, in addition to complications- DM, psychosis, & AVN
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30317-2/fulltext">https://www.thelancet.com/journals/...
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A recent RCT of steroids for ARDS showed that steroids could reduce duration of mechanical ventilation & overall mortality in pts w/ ARDS
Majority of pts had PNA or sepsis as most common cause, but it is not clear whether this was viral or bacteria https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(19)30417-5.pdf">https://www.thelancet.com/pdfs/jour...
A recent RCT of steroids for ARDS showed that steroids could reduce duration of mechanical ventilation & overall mortality in pts w/ ARDS
Majority of pts had PNA or sepsis as most common cause, but it is not clear whether this was viral or bacteria https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(19)30417-5.pdf">https://www.thelancet.com/pdfs/jour...
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Now, for steroids and #COVID19
Retrospective, observational, single center-
In 201 patients with COVID19 pneumonia, 84 (42%) developed ARDS. In patients who developed ARDS, methylprednisolone appeared to reduce the risk of death
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2763184">https://jamanetwork.com/journals/...
Now, for steroids and #COVID19
Retrospective, observational, single center-
In 201 patients with COVID19 pneumonia, 84 (42%) developed ARDS. In patients who developed ARDS, methylprednisolone appeared to reduce the risk of death
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2763184">https://jamanetwork.com/journals/...
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Steroids and #COVID19
Retrospective, observational, single-center-
In 46 patients with respiratory failure, 26 received methylprednisolone. This was associated with improved clinical symptoms and shortened disease course https://www.medrxiv.org/content/10.1101/2020.03.06.20032342v1">https://www.medrxiv.org/content/1...
Steroids and #COVID19
Retrospective, observational, single-center-
In 46 patients with respiratory failure, 26 received methylprednisolone. This was associated with improved clinical symptoms and shortened disease course https://www.medrxiv.org/content/10.1101/2020.03.06.20032342v1">https://www.medrxiv.org/content/1...
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Steroids & #COVID19 - @eeeejjjaaaa
Retrospective, single-center
- 244 critically ill: 151 received steroids, 93 did not
Low dose steroids MAY have some benefit
BUT, increased steroid dosage was significantly associated with elevated mortality risk
https://www.medrxiv.org/content/10.1101/2020.04.07.20056390v1.full.pdf+html">https://www.medrxiv.org/content/1...
Steroids & #COVID19 - @eeeejjjaaaa
Retrospective, single-center
- 244 critically ill: 151 received steroids, 93 did not
Low dose steroids MAY have some benefit
BUT, increased steroid dosage was significantly associated with elevated mortality risk
https://www.medrxiv.org/content/10.1101/2020.04.07.20056390v1.full.pdf+html">https://www.medrxiv.org/content/1...
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CDC and WHO do not recommend steroids at this time, unless using it for another indication (COPD exacerbation, refractory shock)
We will need data from RCTs to know if steroids are helpful for this disease process
CDC and WHO do not recommend steroids at this time, unless using it for another indication (COPD exacerbation, refractory shock)
We will need data from RCTs to know if steroids are helpful for this disease process
