HDCN Abstract:  ASN Annual Meeting 2020 -- Digital Meeting  

Saggi SJ, Nath S, Culas R, et al.

Recovery from AKI and Acute Respiratory Distress Syndrome (ARDS) with the Use of Low-Dose Steroids During COVID-19 Infection in an African American Population: A Retrospective Analysis

ASN Annual Meeting 2020 -- Digital Meeting
J Am Soc Nephrol (Oct) 31:33A 2020

BACKGROUND

Corona Virus Disease-19 (CoVID-19) infection associated with AKI and ARDS results in a mortality of 80%. In AA population COVID 19 presentations and outcomes are worse. NIH and Interim WHO guidelines suggest against steroids use unless in the context of clinical trials. We conducted a retrospective analysis on the impact of 2 different doses of IV steroids in AA adult population.

METHODS

75 patients between March 1 and April 30, 2020 were enrolled. Primary outcomes (21-day mortality) and secondary outcomes (improvement in lung function and renal function) were analyzed. Comparisons between the steroid doses (methylprednisolone 1 mg/kg/day or 2 mg/kg/day) and no-steroid groups were performed with the Wilcoxon, Kruskal-Wallis, and Chi-Square tests. Factors affecting the recovery of AKI or ARDS were analyzed. AKI recovery was defined as 50% increase of GFR, and cessation of RRT; lung function recovery was defined as improved oxygenation by P/F ratio > 200 and extubation.

RESULTS

38 out 75 patients received steroids. Survival in the steroids group reached 73% at 21 days compared to 36% in the non-steroids group (p<0.0006). Steroids improved the likelihood of renal function improvement by 300% (p=0.06). Lung functionwas 73% in the steroids group versus 45% in the other (p=0.01). Use of anticoagulants (16% vs 51%, p= 0.001) seemed to be interacting with steroids on outcomes. Low dose steroids had the most beneficial impact.

CONCLUSION

In patients with COVID-19 infection and ARDS with AKI, low dose IV methylprednisolone was associated with a significantly lower incidence of mortality and higher likelihood of renal and lung function recovery. Further investigation with a randomized control trial consisting of low dose steroids seems warranted.


Mortality in stroids and non-steroids groups

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