Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Retrospective analysis of anti-inflammatory therapies during the first wave of COVID-19 at a community hospital
Jose I Iglesias, Andrew V Vassallo, Jesse B Sullivan, Yasmine Elbaga, Vishal V Patel, Nikunjkumar Patel, Lydia Ayad, Payam Benson, Marina Pittiglio, Emad Gobran, Alexander Clark, Wajahat Khan, Kaliope Damalas, Rajesh Mohan, Satyendra P Singh
Jose I Iglesias, Wajahat Khan, Department of Critical Care, Community Medical Center, Toms River, NJ 08757, United States
Jose I Iglesias, Department of Nephrology, Community Medical Center, Toms River, NJ 08757, United States
Jose I Iglesias, Department of Nephrology, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine at Seton Hall, Neptune, NJ 07753, United States
Andrew V Vassallo, Vishal V Patel, Marina Pittiglio, Kaliope Damalas, Department of Pharmacy, Community Medical Center, Toms River, NJ 08757, United States
Jesse B Sullivan, Fairleigh Dickinson University School of Pharmacy & Health Sciences, Fairleigh Dickinson University, Florham Park, NJ 07932, United States
Yasmine Elbaga, Alexander Clark, Department of Pharmancy, Monmouth Medical Center Southern Campus, Lakewood, NJ 08701, United States
Nikunjkumar Patel, Lydia Ayad, Payam Benson, Emad Gobran, Department of Medicine, Community Medical Center, Toms River, NJ 08757, United States
Rajesh Mohan, Department of Cardiology, Monmouth Medical Center Southern Campus, Lakewood, NJ 08701, United States
Satyendra P Singh, Department of Medicine, Monmouth Medical Center Southern Campus, Lakewood, NJ 08701, United States
Author contributions: Iglesias JI and Vassallo AV contributed to conceptualization, methodology, and formal analysis; Iglesias JI, Vassallo AV, Sullivan JB, Elbaga Y and Patel VV wrote the original draft; Data collection along with manuscript review and editing was performed by Iglesias JI, Vassallo AV, Elbaga Y, Patel N, Gobran E, Ayad L, Pittiglio M, Khan W, Benson P, Damalas K, Clark A, Singh SP, and Mohan R.
Institutional review board statement: The study was approved by the Community Medical Center Institutional Review Board (IRB # 20-005).
Informed consent statement: Informed consent was waived by the Community Medical Center Institutional Review Board as the study was deemed minimal risk to participants due to its retrospective nature and de-identified results.
Conflict-of-interest statement: None of the listed authors have any conflicts of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jose I Iglesias, DO, Associate Professor, Department of Critical Care, Community Medical Center, 99 W Rt 37, Toms River, NJ 08757, United States. jiglesias23@gmail.com
Received: April 21, 2021
Peer-review started: April 21, 2021
First decision: June 17, 2021
Revised: June 23, 2021
Accepted: August 4, 2021
Article in press: August 4, 2021
Published online: September 9, 2021
Processing time: 140 Days and 17.9 Hours
ARTICLE HIGHLIGHTS
Research background
Anti-inflammatory therapies have been the focus of treatment for severe hospitalized coronavirus disease 2019 (COVID-19) patients. Mixed literature has led to multiple approaches to providing these immune-modulating agents to calm the host response which has been shown to cause severe illness. Our study provides a retrospective evaluation of treatment provided to ICU-admitted COVID-19 patients and their outcomes.
Research motivation
Corticosteroids have clearly been the mainstay of treatment for hypoxic COVID-19 patients, but there has been debate on the best approach for additional anti-inflammatory therapies. Studies surrounding tocilizumab have previously shown mixed results complicated by a changing treatment regimen as we learned more about the disease process.
Research objectives
The objective of this evaluation was to evaluate treatment provided to severe COVID-19 patients early in the pandemic at our institution and provide additional guidance on any regimens which were associated with improvement in patient outcomes. What was clear after our assessment was that anti-inflammatory therapies using corticosteroids, potentially in combination with tocilizumab, could provide the best outcomes for our patients.
Research methods
Two hundred and sixty-one patients admitted to two community hospital intensive care units for severe COVID-19 were retrospectively analyzed for risk factors for mortality using propensity matched scoring.
Research results
Patient survival was associated with corticosteroid use, with or without tocilizumab. Timing of administration of corticosteroids was an important factor which determined patient outcomes with delays leading to decreased survival. No differences were found with use of anticoagulation, convalescent plasma, tocilizumab monotherapy, prone ventilation, hydroxychloroquine, azithromycin, or intravenous ascorbic acid use.
Research conclusions
Anti-inflammatory therapy with corticosteroids with or without tocilizumab was associated with the best outcomes in our cohort of severe COVID-19 patients.
Research perspectives
More trials are needed based on the appropriate dose, timing, and duration of corticosteroids in COVID-19. The benefit of tocilizumab and corticosteroids as combination treatment also needs to be explored further in randomized trials.
