Influence of chronic use of corticosteroids and calcineurin inhibitors on COVID-19 clinical outcomes: analysis of a nationwide registry
Por:
Calderón-Parra J, Cuervas-Mons V, Moreno-Torres V, Rubio-Rivas M, Blas PA, Pinilla-Llorente B, Helguera-Amezua C, Jiménez-García N, Pesqueira-Fontan PM, Méndez-Bailón M, Artero A, Gilabert N, Ibánez-Estéllez F, Freire-Castro SJ, Lumbreras-Bermejo C and Antón-Santos JM
Publicada:
1 mar 2022
Ahead of Print:
1 ene 2022
Resumen:
Objectives: The aim of this study was to analyze whether subgroups of immunosuppressive (IS) medications conferred different outcomes in COVID-19.
Methods: The study involved a multicenter retrospective cohort of consecutive immunosuppressed patients (ISPs) hospitalized with COVID-19 from March to July, 2020. The primary outcome was in-hospital mortality. A propensity score-matched (PSM) model comparing ISP and non-ISP was planned, as well as specific PSM models comparing individual IS medications associated with mortality.
Results: Out of 16 647 patients, 868 (5.2%) were on chronic IS therapy prior to admission and were considered ISPs. In the PSM model, ISPs had greater in-hospital mortality (OR 1.25, 95% CI 0.99-1.62), which was related to a worse outcome associated with chronic corticoids (OR 1.89, 95% CI 1.43-2.49). Other IS drugs had no repercussions with regard to mortality risk (including calcineurin inhibitors (CNI); OR 1.19, 95% CI 0.65-2.20). In the pre-planned specific PSM model involving patients on chronic IS treatment before admission, corticosteroids were associated with an increased risk of mortality (OR 2.34, 95% CI 1.43-3.82).
Conclusions: Chronic IS therapies comprise a heterogeneous group of drugs with different risk profiles for severe COVID-19 and death. Chronic systemic corticosteroid therapy is associated with increased mor-tality. On the contrary, CNI and other IS treatments prior to admission do not seem to convey different outcomes. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
Filiaciones:
Calderón-Parra J:
Department of Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
Cuervas-Mons V:
Department of Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
IDIPHISA (Madrid)
Moreno-Torres V:
Department of Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
Rubio-Rivas M:
Department of Internal Medicine, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
Blas PA:
Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
Pinilla-Llorente B:
Department of Internal Medicine, Hospital Universitario Gregorio Marañon, Madrid, Spain
Helguera-Amezua C:
Department of Internal Medicine, Hospital de Cabueñes, Gijón, Asturias, Spain
Jiménez-García N:
Department of Internal Medicine, Hospital Costa del Sol, Marbella, Málaga, Spain
Pesqueira-Fontan PM:
Department of Internal Medicine, Hospital Clínico de Santiago de Compostela, A Coruña, Spain
Méndez-Bailón M:
Department of Internal Medicine, Hospital Clínico San Carlos, Madrid, Spain
:
Department of Internal Medicine, Hospital Universitario Dr Peset, Valencia, Spain
Gilabert N:
Department of Internal Medicine, Hospital Universitario La Princesa, Madrid, Spain
Ibánez-Estéllez F:
Department of Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
Freire-Castro SJ:
Department of Internal Medicine, Hospital Universitario de A Coruña, A Coruña, Spain
Lumbreras-Bermejo C:
Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
Antón-Santos JM:
Department of Internal Medicine, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
gold, Green Published
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