The Neutrophil-to-Lymphocyte Ratio Determines Clinical Efficacy of Corticosteroid Therapy in Patients with COVID-19.

Corticosteroid therapy is now recommended as a treatment in patients with severe COVID-19. But one key question is how to objectively identify severely ill patients who may benefit from such therapy. Here, we assigned 12,862 COVID-19 cases from 21 hospitals in Hubei Province equally to a training and a validation cohort. We found that a neutrophil-to-lymphocyte ratio (NLR) > 6.11 at admission discriminated a higher risk for mortality. Importantly, however, corticosteroid treatment in such individuals was associated with a lower risk of 60-day all-cause mortality. Conversely, in individuals with an NLR ≤ 6.11 or with type 2 diabetes, corticosteroid treatment was not associated with reduced mortality, but rather increased risks of hyperglycemia and infections. These results show that in the studied cohort corticosteroid treatment is associated with beneficial outcomes in a subset of COVID-19 patients who are non-diabetic and with severe symptoms as defined by NLR.

Cai J ，Li H ，Zhang C ，Chen Z ，Liu H ，Lei F ，Qin JJ ，Liu YM ，Zhou F ，Song X ，Zhou J ，Zhao YC ，Wu B ，He M ，Yang H ，Zhu L ，Zhang P ，Ji YX ，Zhao GN ，Lu Z ，Liu L ，Mao W ，Liao X ，Lu H ，Wang D ，Xia X ，Huang X ，Wei X ，Xia J ，Zhang BH ，Yuan Y ，She ZG ，Xu Q ，Ma X ，Wang Y ，Yang J ，Zhang X ，Zhang XJ ，Li H ... -  《-》

Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study.

To assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19). A multicentre observational study was performed from 22 February through 30 June 2020. We included consecutive adult patients with severe COVID-19, defined as respiratory rate ≥30 breath per minute, oxygen saturation ≤93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ≤300 mm Hg. We excluded patients being treated with other immunomodulant drugs, receiving low-dose corticosteroids and receiving corticosteroids 72 hours after admission. The primary endpoint was 30-day mortality from hospital admission. The main exposure variable was corticosteroid therapy at a dose of ≥0.5 mg/kg of prednisone equivalents. It was introduced as binomial covariate in a logistic regression model for the primary endpoint and inverse probability of treatment weighting using the propensity score. Of 1717 patients with COVID-19 evaluated, 513 were included in the study, and of these, 170 (33%) were treated with corticosteroids. During hospitalization, 166 patients (34%) met the criteria of the primary outcome (60/170, 35% in the corticosteroid group and 106/343, 31% in the noncorticosteroid group). At multivariable analysis corticosteroid treatment was not associated with lower 30-day mortality rate (adjusted odds ratio, 0.59; 95% confidence interval (CI), 0.20-1.74; p 0.33). After inverse probability of treatment weighting, corticosteroids were not associated with lower 30-day mortality (average treatment effect, 0.05; 95% CI, -0.02 to 0.09; p 0.12). However, subgroup analysis revealed that in patients with PO2/FiO2 < 200 mm Hg at admission (135 patients, 52 (38%) treated with corticosteroids), corticosteroid treatment was associated with a lower risk of 30-day mortality (23/52, 44% vs. 45/83, 54%; adjusted odds ratio, 0.20; 95% CI, 0.04-0.90; p 0.036). The effect of corticosteroid treatment on mortality might be limited to critically ill COVID-19 patients.

Bartoletti M ，Marconi L ，Scudeller L ，Pancaldi L ，Tedeschi S ，Giannella M ，Rinaldi M ，Bussini L ，Valentini I ，Ferravante AF ，Potalivo A ，Marchionni E ，Fornaro G ，Pascale R ，Pasquini Z ，Puoti M ，Merli M ，Barchiesi F ，Volpato F ，Rubin A ，Saracino A ，Tonetti T ，Gaibani P ，Ranieri VM ，Viale P ，Cristini F ，PREDICO Study Group ... -  《-》

Low-to-moderate dose corticosteroids treatment in hospitalized adults with COVID-19.

Use of corticosteroids is common in the treatment of coronavirus disease 2019, but clinical effectiveness is controversial. We aimed to investigate the association of corticosteroids therapy with clinical outcomes of hospitalized COVID-19 patients. In this single-centre, retrospective cohort study, adult patients with confirmed coronavirus disease 2019 and dead or discharged between 29 December 2019 and 15 February 2020 were studied; 1:1 propensity score matchings were performed between patients with or without corticosteroid treatment. A multivariable COX proportional hazards model was used to estimate the association between corticosteroid treatment and in-hospital mortality by taking corticosteroids as a time-varying covariate. Among 646 patients, the in-hospital death rate was higher in 158 patients with corticosteroid administration (72/158, 45.6% vs. 56/488, 11.5%, p < 0.0001). After propensity score matching analysis, no significant differences were observed in in-hospital death between patients with and without corticosteroid treatment (47/124, 37.9% vs. 47/124, 37.9%, p 1.000). When patients received corticosteroids before they required nasal high-flow oxygen therapy or mechanical ventilation, the in-hospital death rate was lower than that in patients who were not administered corticosteroids (17/86, 19.8% vs. 26/86, 30.2%, log rank p 0.0102), whereas the time from admission to clinical improvement was longer (13 (IQR 10-17) days vs. 10 (IQR 8-13) days; p < 0.001). Using the Cox proportional hazards regression model accounting for time varying exposures in matched pairs, corticosteroid therapy was not associated with mortality difference (HR 0.98, 95% CI 0.93-1.03, p 0.4694). Corticosteroids use in COVID-19 patients may not be associated with in-hospital mortality.

Liu Z ，Li X ，Fan G ，Zhou F ，Wang Y ，Huang L ，Yu J ，Yang L ，Shang L ，Xie K ，Xu J ，Huang Z ，Gu X ，Li H ，Zhang Y ，Wang Y ，Huang Z ，Cao B ... -  《-》

Comparative outcomes of combined corticosteroid and remdesivir therapy with corticosteroid monotherapy in ventilated COVID-19 patients.

Mandadi S ，Pulluru H ，Annie F 《PLoS One》

Immunometabolic signatures predict risk of progression to sepsis in COVID-19.

Herrera-Van Oostdam AS ，Castañeda-Delgado JE ，Oropeza-Valdez JJ ，Borrego JC ，Monárrez-Espino J ，Zheng J ，Mandal R ，Zhang L ，Soto-Guzmán E ，Fernández-Ruiz JC ，Ochoa-González F ，Trejo Medinilla FM ，López JA ，Wishart DS ，Enciso-Moreno JA ，López-Hernández Y ... -  《PLoS One》