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Calcifediol or Corticosteroids in the Treatment of COVID-19: An Observational Study
Marta Entrenas-Castillo1,2, Luis Manuel Entrenas-Costa1,2,3, María P Pata4
1Hospital QuironSalud Córdoba, 14004 Córdoba, Spain.
Insights
Calcifediol treatment may reduce COVID-19 severity and ICU admissions. This study suggests calcifediol, not corticosteroids, may be the preferred treatment for hospitalized COVID-19 patients to avoid hyperinflammation.
Area of Science:
- Infectious Diseases
- Endocrinology
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) presents a significant therapeutic challenge.
- Calcifediol and corticosteroids show similar action profiles in treating COVID-19.
- Combined use of calcifediol and corticosteroids may alter individual treatment contributions.
Purpose of the Study:
- To assess the impact of calcifediol and/or corticosteroid treatment on ICU admission, mortality, and prognosis in hospitalized COVID-19 patients.
- To evaluate treatment modifications during the initial COVID-19 outbreaks.
Main Methods:
- Retrospective observational cohort study conducted at Hospital Universitario Reina Sofía, Spain.
- Patients received calcifediol, corticosteroids, both, or neither, alongside standard care.
- Key outcomes measured included ICU admission, death, and poor prognosis.
Main Results:
- Calcifediol treatment was associated with significantly lower ICU admission rates (15% vs. 26%, p < 0.01).
- Patients receiving calcifediol without corticosteroids had the lowest ICU admission rate (5.8%).
- Calcifediol use strongly correlated with a good prognosis (p < 0.001), unlike corticosteroid use.
Conclusions:
- Calcifediol may be the preferred treatment for hospitalized patients with mild to moderate COVID-19.
- Corticosteroids might be best avoided until the disease progresses to a hyperinflammatory stage.
- Further research into calcifediol's role in managing COVID-19 is warranted.
Abstract:
Medical treatment of coronavirus 19 disease (COVID-19) is a therapeutic challenge. The available data strongly suggest that calcifediol treatment may reduce the severity of COVID-19, and corticosteroids are the treatment of choice worldwide for severe COVID-19. Both have a very similar action profile, and their combined use in patients may modify the contribution of each administered compound.
Objective:
To evaluate how treatment with calcifediol and/or corticosteroids in medical practice modified the need for ICU admission, death, or poor prognosis of patients hospitalized with COVID-19 during the first outbreaks.
Design, Patients And Setting:
A retrospective observational cohort study of patients admitted for COVID-19 to the Pneumology Unit of the Hospital Universitario Reina Sofía (Córdoba, Spain).
Interventions:
Patients were treated with calcifediol or/and corticosteroids with the best available therapy and standard care, according to clinical practice guidelines.
Measurements:
Admission to the intensive care unit (ICU) or death during hospitalization and poor prognosis.
Results:
Seven hundred and twenty-eight patients were included. According to the treatment received, they were included in four groups: calcifediol (n = 68), glucocorticoids (n = 112), both (n = 510), or neither (n = 38). Of the 578 patients treated with calcifediol, 88 were admitted to the ICU (15%), while of the 150 not treated with calcifediol, 39 required ICU admission (26%) (p < 0.01). Among the patients taking calcifediol without glucocorticoids, only 4 of 68 (5.8%) required ICU admission, compared to 84 of 510 (16.5%) treated with both (p = 0.022). Of the 595 patients who had a good prognosis, 568 (82.01%) had received treatment with calcifediol versus the 133 patients with a poor prognosis, of whom 90 (67.66%) had received calcifediol (p < 0.001). This difference was not found for corticosteroids.
Interpretation:
The treatment of choice for hospitalized patients with moderate or mild COVID-19 could be calcifediol, not administering corticosteroids, until the natural history of the disease reaches a stage of hyperinflammation.
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