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Association of Early Steroid Administration With Outcomes of Children Hospitalized for COVID-19 Without Multisystem Inflammatory Syndrome in Children
Nadiger, Meghana , McGarvey, Jeremy , Harthan, Aaron A. , Lombardo, Mónica, Perkins, Nicholas , Sayed, Imran A., Bhalala, Utpal , Raju, Umamaheswara, Miller, Aaron S., Boman, Karen , Arteaga, Grace M. , Bansal, Vikas , Tekin, Aysun , Kumar, Vishakha K. , Group, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator, Kovačević, Tanja , Markić, Joško , Ardalic, Tatjana Capitovic , Polić, Branka , Ivić, Ivo, Carev, Dominko , Glavinić, Robert, Vadgaonkar, Girish, Ediga, Rekha, Basety, Shilpa, Dammareddy, Shwetha, Kasumalla, Phani Sreeharsha, Manduva, Janaki, Kolakani, Naresh, Sripathi, Shreeja , Chaitanya, Sheetal, Papani, Sridhar, Kamuram, Mahesh, Mohan, Surapaneni Krishna, Jyothisree, Ekambaram, Petrolwala, Mukur, Ladva, Bharat, Kodate, Akira, Suzuki, Reina , Moriki, Koyo, Hassan-Hanga, Fatimah , Gezawa, Abubakar Shehu, Kabara, Halima M. 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JAMA Pediatrics | October 3, 2022 | Volume: 176 | Issue: 12 | Pages: 1208
10.1001/jamapediatrics.2022.3611
ImportanceThere is limited evidence for therapeutic options for pediatric COVID-19 outside of multisystem inflammatory syndrome in children (MIS-C).ObjectiveTo determine whether the use of steroids within 2 days of admission for non–MIS-C COVID-19 in children is associated with hospital length of stay (LOS). The secondary objective was to determine their association with intensive care unit (ICU) LOS, inflammation, and fever defervescence.Design, Setting, and ParticipantsThis cohort study analyzed data retrospectively for children (<18 years) who required hospitalization for non–MIS-C COVID-19. Data from March 2020 through September 2021 were provided by 58 hospitals in 7 countries who participate in the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry.ExposureAdministration of steroids within 2 days of admission.Main Outcomes and MeasuresLength of stay in the hospital and ICU. Adjustment for confounders was done by mixed linear regression and propensity score matching.ResultsA total of 1163 patients met inclusion criteria and had a median (IQR) age of 7 years (0.9-14.3). Almost half of all patients (601/1163, 51.7%) were male, 33.8% (392/1163) were non-Hispanic White, and 27.9% (324/1163) were Hispanic. Of the study population, 184 patients (15.8%) received steroids within 2 days of admission, and 979 (84.2%) did not receive steroids within the first 2 days. Among 1163 patients, 658 (56.5%) required respiratory support during hospitalization. Overall, patients in the steroids group were older and had greater severity of illness, and a larger proportion required respiratory and vasoactive support. On multivariable linear regression, after controlling for treatment with remdesivir within 2 days, country, race and ethnicity, obesity and comorbidity, number of abnormal inflammatory mediators, age, bacterial or viral coinfection, and disease severity according to ICU admission within first 2 days or World Health Organization ordinal scale of 4 or higher on admission, with a random intercept for the site, early steroid treatment was not significantly associated with hospital LOS (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Separate analyses for patients with an LOS of 2 days or longer (n = 729), those receiving respiratory support at admission (n = 286), and propensity score–matched patients also showed no significant association between steroids and LOS. Early steroid treatment was not associated with ICU LOS, fever defervescence by day 3, or normalization of inflammatory mediators.Conclusions and RelevanceSteroid treatment within 2 days of hospital admission in a heterogeneous cohort of pediatric patients hospitalized for COVID-19 without MIS-C did not have a statistically significant association with hospital LOS.
Metabolic Syndrome and Acute Respiratory Distress Syndrome in Hospitalized Patients With COVID-19
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JAMA Network Open | December 22, 2021 | Volume: 4 | Issue: 12 | Pages: e2140568
Outcomes of Patients With Coronavirus Disease 2019 Receiving Organ Support Therapies: The International Viral Infection and Respiratory Illness Universal Study Registry
Domecq, Juan Pablo , Lal, Amos , Sheldrick, Christopher R., Kumar, Vishakha K. , Boman, Karen , Bolesta, Scott , Bansal, Vikas , Garcia, Michael A. , Kaufman, Margit, Danesh, Valerie , Anderson, Harry L., Milligan, Patrick S., Denson, Joshua L. , Hill, Catherine A. St., Dodd, Kenneth W. , Gajić, Ognjen, Kashyap, Rahul , Tierney, David M. , Camazine, Maraya , Dapul, Heda , Gharpure, Varsha , Koritala, Thoyaja , Заболотских, И. Б. , Kovačević, Peđja , Asghar, Muhammad Sohaib , McGonagill, Patrick W. , El‐Kassas, Mohamed , Parameswaran, Sreejith , Iwasaki, Yudai , Nenadić, Irina , Djuric, Marko , Lutrick, Karen , Lumelsky, David , Minear, Steven , Tarabichi, Yasir , Dy, Rajany , Galet, Colette , West, T. Eoin , Wilfong, Erin M. , Ramírez, Michelle , Law, Anica C. , Lal, Amos , Bansal, Vikas , Denson, Joshua L , Kashyap, Rahul , Gharpure, Varsha P , Asghar, Muhammad S , Domecq Graces, Juan Pablo , Sheldrick, Christopher R., Harhay, Michael Oscar , Cheruku, Sreekanth , Banner‐Goodspeed, Valerie , Anderson, Harry L., Martin, Greg S. , Gajic, Ognjen , Walkey, Allan J.
Critical Care Medicine | January 29, 2021 | Volume: 49 | Issue: 3 | Pages: 437-448
OBJECTIVES: To describe the outcomes of hospitalized patients in a multicenter, international coronavirus disease 2019 registry. DESIGN: Cross-sectional observational study including coronavirus disease 2019 patients hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 infection between February 15, 2020, and November 30, 2020, according to age and type of organ support therapies. SETTING: About 168 hospitals in 16 countries within the Society of Critical Care Medicine’s Discovery Viral Infection and Respiratory Illness University Study coronavirus disease 2019 registry. PATIENTS: Adult hospitalized coronavirus disease 2019 patients who did and did not require various types and combinations of organ support (mechanical ventilation, renal replacement therapy, vasopressors, and extracorporeal membrane oxygenation). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary outcome was hospital mortality. Secondary outcomes were discharge home with or without assistance and hospital length of stay. Risk-adjusted variation in hospital mortality for patients receiving invasive mechanical ventilation was assessed by using multilevel models with hospitals as a random effect, adjusted for age, race/ethnicity, sex, and comorbidities. Among 20,608 patients with coronavirus disease 2019, the mean (± sd ) age was 60.5 (±17), 11,1887 (54.3%) were men, 8,745 (42.4%) were admitted to the ICU, and 3,906 (19%) died in the hospital. Hospital mortality was 8.2% for patients receiving no organ support ( n = 15,001). The most common organ support therapy was invasive mechanical ventilation ( n = 5,005; 24.3%), with a hospital mortality of 49.8%. Mortality ranged from 40.8% among patients receiving only invasive mechanical ventilation ( n =1,749) to 71.6% for patients receiving invasive mechanical ventilation, vasoactive drugs, and new renal replacement therapy ( n = 655). Mortality was 39% for patients receiving extracorporeal membrane oxygenation ( n = 389). Rates of discharge home ranged from 73.5% for patients who did not require organ support therapies to 29.8% for patients who only received invasive mechanical ventilation, and 8.8% for invasive mechanical ventilation, vasoactive drugs, and renal replacement; 10.8% of patients older than 74 years who received invasive mechanical ventilation were discharged home. Median hospital length of stay for patients on mechanical ventilation was 17.1 days (9.7-28 d). Adjusted interhospital variation in mortality among patients receiving invasive mechanical ventilation was large (median odds ratio 1.69). CONCLUSIONS: Coronavirus disease 2019 prognosis varies by age and level of organ support. Interhospital variation in mortality of mechanically ventilated patients was not explained by patient characteristics and requires further evaluation.