David J Douin, Martin Krause, Cynthia Williams, Kenji Tanabe, Ana Fernandez-Bustamante, Aurora N Quaye, Adit A Ginde, Karsten Bartels
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The primary outcome was days spent with at least 1 episode of blood glucose either >180 mg/dL or <80 mg/dL within the first 28 days of admission.</p><p><strong>Setting: </strong>Twelve hospitals in a United States health system.</p><p><strong>Patients: </strong>Adults diagnosed with COVID-19 requiring invasive mechanical ventilation and/or veno-venous extracorporeal membrane oxygenation.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We included 292 mechanically ventilated patients. We fitted a quantile regression model to assess the association between steroid administration ≥320 mg methylprednisolone (equivalent to 60 mg dexamethasone) and impaired glycemic control. Sixty-six patients (22.6%) died within 28 days of intensive care unit admission. Seventy-one patients (24.3%) received a cumulative dose of least 320 mg methylprednisolone equivalents. After adjustment for gender, history of diabetes mellitus, chronic liver disease, sequential organ failure assessment score on intensive care unit day 1, and length of stay, administration of ≥320 mg methylprednisolone equivalent was associated with 4 additional days spent with glucose either <80 mg/dL or >180 mg/dL (B = 4.00, 95% CI = 2.15-5.85, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>In this cohort study of 292 mechanically ventilated COVID-19 patients, we found an association between corticosteroid administration and higher incidence of both hyperglycemia and hypoglycemia.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.1000,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8927893/pdf/10.1177_10892532211043313.pdf","citationCount":"5","resultStr":"{\"title\":\"Corticosteroid Administration and Impaired Glycemic Control in Mechanically Ventilated COVID-19 Patients.\",\"authors\":\"David J Douin, Martin Krause, Cynthia Williams, Kenji Tanabe, Ana Fernandez-Bustamante, Aurora N Quaye, Adit A Ginde, Karsten Bartels\",\"doi\":\"10.1177/10892532211043313\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Recent clinical trials confirmed the corticosteroid dexamethasone as an effective treatment for patients with COVID-19 requiring mechanical ventilation. However, limited attention has been given to potential adverse effects of corticosteroid therapy. The objective of this study was to determine the association between corticosteroid administration and impaired glycemic control among COVID-19 patients requiring mechanical ventilation and/or veno-venous extracorporeal membrane oxygenation.</p><p><strong>Design: </strong>Multicenter retrospective cohort study between March 9 and May 17, 2020. The primary outcome was days spent with at least 1 episode of blood glucose either >180 mg/dL or <80 mg/dL within the first 28 days of admission.</p><p><strong>Setting: </strong>Twelve hospitals in a United States health system.</p><p><strong>Patients: </strong>Adults diagnosed with COVID-19 requiring invasive mechanical ventilation and/or veno-venous extracorporeal membrane oxygenation.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We included 292 mechanically ventilated patients. We fitted a quantile regression model to assess the association between steroid administration ≥320 mg methylprednisolone (equivalent to 60 mg dexamethasone) and impaired glycemic control. Sixty-six patients (22.6%) died within 28 days of intensive care unit admission. Seventy-one patients (24.3%) received a cumulative dose of least 320 mg methylprednisolone equivalents. After adjustment for gender, history of diabetes mellitus, chronic liver disease, sequential organ failure assessment score on intensive care unit day 1, and length of stay, administration of ≥320 mg methylprednisolone equivalent was associated with 4 additional days spent with glucose either <80 mg/dL or >180 mg/dL (B = 4.00, 95% CI = 2.15-5.85, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>In this cohort study of 292 mechanically ventilated COVID-19 patients, we found an association between corticosteroid administration and higher incidence of both hyperglycemia and hypoglycemia.</p>\",\"PeriodicalId\":46500,\"journal\":{\"name\":\"Seminars in Cardiothoracic and Vascular Anesthesia\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2022-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8927893/pdf/10.1177_10892532211043313.pdf\",\"citationCount\":\"5\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Seminars in Cardiothoracic and Vascular Anesthesia\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/10892532211043313\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/9/2 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Seminars in Cardiothoracic and Vascular Anesthesia","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/10892532211043313","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/9/2 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 5
摘要
目的:最近的临床试验证实皮质类固醇地塞米松是治疗COVID-19需要机械通气患者的有效方法。然而，对皮质类固醇治疗的潜在不良反应的关注有限。本研究的目的是确定在需要机械通气和/或静脉-静脉体外膜氧合的COVID-19患者中皮质类固醇给药与血糖控制受损之间的关系。设计:2020年3月9日至5月17日之间的多中心回顾性队列研究。主要终点是至少1次血糖≥180mg /dL的天数，或设定:美国卫生系统的12家医院。患者:确诊为COVID-19的成年人，需要有创机械通气和/或静脉-静脉体外膜氧合。干预措施:没有。测量方法及主要结果:纳入292例机械通气患者。我们拟合了一个分位数回归模型来评估类固醇给药≥320 mg甲基强的松龙(相当于60 mg地塞米松)与血糖控制受损之间的关系。66例(22.6%)患者在重症监护病房入住28天内死亡。71名患者(24.3%)接受了至少320 mg甲基强的松龙当量的累积剂量。在调整性别、糖尿病史、慢性肝病、重症监护病房第1天序性器官衰竭评估评分和住院时间后，给药≥320 mg甲基强龙当量与额外4天葡萄糖≥180 mg/dL相关(B = 4.00, 95% CI = 2.15-5.85, P < 0.001)。结论:在这项对292例机械通气的COVID-19患者的队列研究中，我们发现皮质类固醇给药与高血糖和低血糖的高发生率之间存在关联。
Corticosteroid Administration and Impaired Glycemic Control in Mechanically Ventilated COVID-19 Patients.
Objective: Recent clinical trials confirmed the corticosteroid dexamethasone as an effective treatment for patients with COVID-19 requiring mechanical ventilation. However, limited attention has been given to potential adverse effects of corticosteroid therapy. The objective of this study was to determine the association between corticosteroid administration and impaired glycemic control among COVID-19 patients requiring mechanical ventilation and/or veno-venous extracorporeal membrane oxygenation.
Design: Multicenter retrospective cohort study between March 9 and May 17, 2020. The primary outcome was days spent with at least 1 episode of blood glucose either >180 mg/dL or <80 mg/dL within the first 28 days of admission.
Setting: Twelve hospitals in a United States health system.
Measurements and main results: We included 292 mechanically ventilated patients. We fitted a quantile regression model to assess the association between steroid administration ≥320 mg methylprednisolone (equivalent to 60 mg dexamethasone) and impaired glycemic control. Sixty-six patients (22.6%) died within 28 days of intensive care unit admission. Seventy-one patients (24.3%) received a cumulative dose of least 320 mg methylprednisolone equivalents. After adjustment for gender, history of diabetes mellitus, chronic liver disease, sequential organ failure assessment score on intensive care unit day 1, and length of stay, administration of ≥320 mg methylprednisolone equivalent was associated with 4 additional days spent with glucose either <80 mg/dL or >180 mg/dL (B = 4.00, 95% CI = 2.15-5.85, P < .001).
Conclusions: In this cohort study of 292 mechanically ventilated COVID-19 patients, we found an association between corticosteroid administration and higher incidence of both hyperglycemia and hypoglycemia.
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