Title Page The Impact Of Corticosteroids On Secondary Infection And Mortality In Critically Ill Covid-19 Patients

Levine, Andrea R. (2021) Title Page The Impact Of Corticosteroids On Secondary Infection And Mortality In Critically Ill Covid-19 Patients. Master's Thesis, University of Pittsburgh. (Unpublished)

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Abstract

Background: Corticosteroids are part of the treatment guidelines for COVID-19 and have been shown to improve mortality. However, the impact corticosteroids have on the development of secondary infection in COVID-19 is unknown. We sought to define the rate of secondary infection in critically ill patients with COVID-19 and to determine the effect of corticosteroid use on mortality in critically ill patients with COVID-19.

Study Design and Methods: One hundred and thirty-five critically ill patients with COVID-19 admitted to the Intensive Care Unit (ICU) at the University of Maryland Medical Center were included in this single-center retrospective analysis. Demographics, symptoms, culture data, use of COVID-19 directed therapies, and outcomes were abstracted from the medical record. The primary outcomes were secondary infection and mortality. Proportional hazards models were used to determine the time to secondary infection and the time to death.

Results: The proportion of patients with secondary infection was 63%. The likelihood of developing secondary infection was not significantly impacted by the administration of corticosteroids (HR 1.45, CI 0.75-2.82, p=0.28). This remained consistent in sub-analysis looking at bloodstream, respiratory, and urine infections. Secondary infection had no significant impact on the likelihood of 28-day mortality (HR 0.66, CI 0.33-1.35, p=0.256). Corticosteroid administration significantly reduced the likelihood of 28-day mortality (HR 0.27, CI 0.10-0.72, p=0.01).

Conclusion: Corticosteroids are an important and lifesaving pharmacotherapeutic option in critically ill patients with COVID-19 which have no impact on the likelihood of developing secondary infections. Confirming the safety of this relatively accessible pharmacotherapeutic option for critically ill patients with COVID-19 amongst a dearth of other effective pharmacotherapeutics of utmost public health significance.

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Details

Item Type:	University of Pittsburgh ETD
Status:	Unpublished
Creators/Authors:	Creators Email Pitt Username ORCID Levine, Andrea R. levinear@pitt.edu levinear
ETD Committee:	Title Member Email Address Pitt Username ORCID Committee Member Songer, Thomas tjs@pitt.edu tjs Committee Member Bain, William bainwg@upmc.edu Thesis Advisor Glynn, Nancy EPIDNWG@pitt.edu epidnwg
Date:	27 August 2021
Date Type:	Publication
Defense Date:	27 July 2021
Approval Date:	27 August 2021
Submission Date:	1 August 2021
Access Restriction:	2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages:	60
Institution:	University of Pittsburgh
Schools and Programs:	School of Public Health > Epidemiology
Degree:	MS - Master of Science
Thesis Type:	Master's Thesis
Refereed:	Yes
Uncontrolled Keywords:	COVID-19, corticosteroids, secondary infection
Date Deposited:	27 Aug 2021 19:30
Last Modified:	27 Aug 2023 05:15
URI:	http://d-scholarship.pitt.edu/id/eprint/41541

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