Evolution of the Use of Corticosteroids for the Treatment of Hospitalised COVID-19 Patients in Spain between March and November 2020: SEMI-COVID National Registry

OBJECTIVES

Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence of new recommendations.

MATERIAL AND METHODS

A retrospective, descriptive, and observational study was conducted on adults hospitalised due to COVID-19 in Spain who were included in the SEMI-COVID-19 Registry from March to November 2020.

RESULTS

CTs were used in 6053 (36.21%) of the included patients. The patients were older (mean (SD)) (69.6 (14.6) vs. 66.0 (16.8) years; p < 0.001), with hypertension (57.0% vs. 47.7%; p < 0.001), obesity (26.4% vs. 19.3%; p < 0.0001), and multimorbidity prevalence (20.6% vs. 16.1%; p < 0.001). These patients had higher values (mean (95% CI)) of C-reactive protein (CRP) (86 (32.7-160) vs. 49.3 (16-109) mg/dL; p < 0.001), ferritin (791 (393-1534) vs. 470 (236-996) µg/dL; p < 0.001), D dimer (750 (430-1400) vs. 617 (345-1180) µg/dL; p < 0.001), and lower Sp02/Fi02 (266 (91.1) vs. 301 (101); p < 0.001). Since June 2020, there was an increment in the use of CTs (March vs. September; p < 0.001). Overall, 20% did not receive steroids, and 40% received less than 200 mg accumulated prednisone equivalent dose (APED). Severe patients are treated with higher doses. The mortality benefit was observed in patients with oxygen saturation

CONCLUSIONS

Patients with greater comorbidity, severity, and inflammatory markers were those treated with CTs. In severe patients, there is a trend towards the use of higher doses. The mortality benefit was observed in patients with oxygen saturation Collapse

Key Words

• COVID-19
• Spain
• comorbidities
• corticosteroids

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Affiliation(s)

David Balaz Department of Internal Medicine, Hospital Universitario San Juan de Alicante, 03550 Alicante, Spain Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, 03202 Alicante, Spain
Philip Erick Wikman-Jorgensen Department of Internal Medicine, Hospital Universitario San Juan de Alicante, 03550 Alicante, Spain Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, 03202 Alicante, Spain
Vicente Giner Galvañ Department of Internal Medicine, Hospital Universitario San Juan de Alicante, 03550 Alicante, Spain Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, 03202 Alicante, Spain Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Conselleria de Sanitat, 46010 Valencia, Spain
Manuel Rubio-Rivas Department of Internal Medicine, Hospital Universitario de Bellvitge, 08907 Barcelona, Spain;
Borja de Miguel Campo Department of Internal Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
Mariam Noureddine López Department of Internal Medicine, Hospital Costa del Sol, 29603 Málaga, Spain;
Juan Francisco López Caleya Department of Internal Medicine, Hospital de Cabueñes, 33394 Gijón, Asturias, Spain;
Ricardo Gómez Huelgas Department of Internal Medicine, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain;
Paula María Pesqueira Fontán Department of Internal Medicine, Hospital Clínico de Santiago de Compostela, 15706 A Coruña, Spain;
Manuel Méndez Bailón Department of Internal Medicine, Hospital Clínico San Carlos, 28040 Madrid, Spain;
Mar Fernández-Garcés Department of Internal Medicine, Hospital Universitario Dr. Peset, 46017 Valencia, Spain;
Ana Fernández Cruz Department of Internal Medicine, Hospital Universitario Puerta de Hierro-Majadahonda, 28222 Madrid, Spain;
Gema María García García Department of Internal Medicine, Complejo Hospitalario Universitario de Badajoz, 06010 Badajoz, Spain;
Nicolás Rhyman Department of Internal Medicine, Hospital Moisès Broggi, Sant Joan Despí, 08970 Barcelona, Spain;
Luis Corral-Gudino Department of Internal Medicine, Hospital Universitario Río Hortega, 47012 Valladolid, Spain;
Aquiles Lozano Rodríguez-Mancheño Department of Internal Medicine, Hospital Alto Guadalquivir, 23740 Jaén, Spain;
María Navarro De La Chica Department of Internal Medicine, Hospital Nuestra Señora del Prado, 45600 Toledo, Spain;
Andrea Torregrosa García Department of Internal Medicine, Hospital General Universitario de Elda, 03600 Alicante, Spain;
José Nicolás Alcalá Department of Internal Medicine, Hospital de Pozoblanco, 14400 Córdoba, Spain;
Pablo Díaz Jiménez Department of Internal Medicine, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain;
Leticia Esther Royo Trallero Department of Internal Medicine, Hospital General Defensa, 50009 Zaragoza, Spain;
Pere Comas Casanova Department of Internal Medicine, Hospital Comarcal de Blanes, 17300 Girona, Spain;
Jesús Millán Núñez-Cortés Department of Internal Medicine, Hospital Universitario Gregorio Marañón, 28007 Madrid, Spain;
José-Manuel Casas-Rojo Department of Internal Medicine, Hospital Infanta Cristina University Hospital, 28981 Madrid, Spain;
on behalf of the SEMI-COVID-19 Network

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Lipoprotein (a) levels and outcomes in stable outpatients with symptomatic artery disease

BACKGROUND AND AIMS

Although genetic and epidemiological studies support that people with high lipoprotein (a) [Lp(a)] levels are at an increased risk for arterial disease, its prognostic value in patients with established artery disease has not been consistently evaluated.

METHODS

FRENA is a prospective registry of consecutive outpatients with coronary, cerebrovascular or peripheral artery disease. We assessed the risk for subsequent myocardial infarction, ischemic stroke or limb amputation according to Lp(a) levels at baseline.

RESULTS

As of December 2016, 1503 stable outpatients were recruited. Of these, 814 (54%) had levels <30 mg/dL, 319 (21%) had 30-50 mg/dL and 370 (25%) had ≥50 mg/dL. Over a mean follow-up of 36 months, 294 patients developed subsequent events (myocardial infarction 122, ischemic stroke 114, limb amputation 58) and 85 died. On multivariable analysis, patients with Lp(a) levels of 30-50 mg/dL were at a higher risk for myocardial infarction (hazard ratio [HR]: 4.67; 95%CI: 2.77-7.85), ischemic stroke (HR: 8.27; 95%CI: 4.14-16.5) or limb amputation (HR: 3.18; 95%CI: 1.36-7.44) than those with normal levels. Moreover, patients with levels ≥50 mg/dL were at increased risk for myocardial infarction (HR: 19.5; 95%CI: 10.5-36.1), ischemic stroke (HR: 54.5; 95%CI: 25.4-116.7) or limb amputation (HR: 22.7; 95%CI: 9.38-54.9).

CONCLUSIONS

Stable outpatients with symptomatic artery disease and Lp(a) levels >30 mg/dL were at a 5-fold higher risk for subsequent myocardial infarction, stroke or limb amputation. Those with levels >50 mg/dL were at an over 10-fold higher risk.