A Retrospective Controlled Cohort Study of the Impact of Glucocorticoid Treatment in SARS-CoV-2 Infection Mortality

  1. Ana Fernández-Cruz
  2. Belén Ruiz-Antorán
  3. Ana Muñoz-Gómez
  4. Aránzazu Sancho-López
  5. Patricia Mills-Sánchez
  6. Gustavo Adolfo Centeno-Soto
  7. Silvia Blanco-Alonso
  8. Laura Javaloyes-Garachana
  9. Amy Galán-Gómez
  10. Ángela Valencia-Alijo
  11. Javier Gómez-Irusta
  12. Concepción Payares-Herrera
  13. Ignacio Morrás-Torre
  14. Enrique Sánchez-Chica
  15. Laura Delgado-Téllez-de-Cepeda
  16. Alejandro Callejas-Díaz
  17. Antonio Ramos-Martínez
  18. Elena Múñez-Rubio
  19. Cristina Avendaño-Solá

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Abstract

Evidence to support the use of steroids in coronavirus disease 2019 (COVID-19) pneumonia is lacking. We aim to determine the impact of steroid use for COVID-19 pneumonia on hospital mortality. We performed a single-center retrospective cohort study in a university hospital in Madrid, Spain, during March of 2020. To determine the role of steroids in in-hospital mortality, patients admitted with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia and treated with steroids were compared to patients not treated with steroids, and we adjusted with a propensity score for patients on steroid treatment.

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  1. Version published to 10.1128/aac.01168-20
  2. ScreenIT

    SciScore for 10.1101/2020.05.22.20110544: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: A hazard ratio (HR) or an odds ratio (OR) was reported along with 95% confidence interval (CI). 7. Ethics: The study was approved by the Institutional Review Board (CEIm) at Hospital Universitario Puerta de Hierro-Majadahonda (BRA-COR-2020–03), and a waiver for the informed consent was granted.
    Consent: A hazard ratio (HR) or an odds ratio (OR) was reported along with 95% confidence interval (CI). 7. Ethics: The study was approved by the Institutional Review Board (CEIm) at Hospital Universitario Puerta de Hierro-Majadahonda (BRA-COR-2020–03), and a waiver for the informed consent was granted.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were performed using SPSS system (version 26.0 for Windows, SPSS Inc., Chicago, IL, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    To overcome this limitation, we applied two propensity scores to the analysis, one for steroid treatment versus no steroid treatment and the second one, for the initial steroid regimen choice. Results were confirmed when including the propensity scores. As a single center study, the results need external validation. The only outcome that was evaluated in the study was mortality. We consider that ICU admission during the study period is not a reliable marker of poor outcome, given the scarcity of available ICU beds during that critical moments of the pandemic, which forced to apply strict restrictions for ICU admission. The potential impact of steroids in the mortality of COVID-19 pneumonia suggested by this study supports the need to carry out randomized clinical trials with the aim to establish their role. The optimal timing for administration, the subset of patients with the best risk/benefit ratio and the appropriate dosing and duration remain to be elucidated.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.05.22.20110544 on medRxiv