López Zúñiga, Miguel ÁngelMoreno-Moral, AidaOcaña-Granados, AnaPadilla-Moreno, Francisco AndrésCastillo-Fernández, Alba MaríaGuillamón-Fernández, DionisioRamírez-Sánchez, CarolinaSanchez-Palop, MaríaMartínez-Colmenero, JustoPimentel-Villar, María AmparoBlázquez-Roselló, SaraMoreno-Sánchez, José JuanLópez-Vílchez, MaríaPrior-Sánchez, InmaculadaJódar-Moreno, RosarioLópez Ruz, Miguel Ángel2023-02-092023-02-092021-01-28http://hdl.handle.net/10668/17063Test whether high dose corticosteroid pulse therapy (HDCPT) with either methylprednisolone or dexamethasone is associated with increased survival in COVID-19 patients at risk of hyper-inflammatory response. Provide some initial diagnostic criteria using laboratory markers to stratify these patients. This is a prospective observational study, 318 met the inclusion criteria. 64 patients (20.1%) were treated with HDCPT by using at least 1.5mg/kg/24h of methylprednisolone or dexamethasone equivalent. A multivariate Cox regression (controlling for co-morbidities and other therapies) was carried out to determine whether HDCPT (among other interventions) was associated with decreased mortality. We also carried out a 30-day time course analysis of laboratory markers between survivors and non-survivors, to identify potential markers for patient stratification. HDCPT showed a statistically significant decrease in mortality (HR = 0.087 [95% CI 0.021-0.36]; P = 40 pg/ml, and/or two of the following: C-reactive protein > = 100 mg/L, D-dimer > = 1000 ng/ml, ferritin > = 500 ng/ml and lactate dehydrogenase > = 300 U/L). HDCPT can be an effective intervention to increase COVID-19 survival rates in patients at risk of developing a COVID-19 hyper-inflammatory response, laboratory marker tests can be used to stratify these patients who should be given HDCPT. This study is not a randomized clinical trial (RCT). Future RCTs should be carried out to confirm the efficacy of HDCPT to increase the survival rates of COVID-19.enAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/Adrenal Cortex HormonesAdultAgedCOVID-19Cytokine Release SyndromeDexamethasoneFemaleHospitalizationHumansInflammationMaleMethylprednisoloneMiddle AgedProspective StudiesSARS-CoV-2SpainSurvival RateCOVID-19 Drug Treatmentresearch article33507958open access10.1371/journal.pone.02439641932-6203PMC7842890https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0243964&type=printablehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7842890/pdf