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Vol. 222. Issue 5.
Pages 310-311 (May 2022)
Vol. 222. Issue 5.
Pages 310-311 (May 2022)
Correspondence
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Answer to the “Glucocorticoid therapy in patients with COVID-19 and concurrent heart failure” correspondence
Respuesta a la carta «Tratamiento con glucocorticoides en pacientes con COVID-19 e insuficiencia cardíaca concurrente»
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A. Salinas-Botrána,
Corresponding author
asalinasbotran@yahoo.es

Corresponding authors.
, L.M. Pérez-Belmonteb,
Corresponding author
luismiguelpb1984@gmail.com

Corresponding authors.
, M. Méndez-Bailóna, en representación del grupo SEMI-COVID-19 Network
a Servicio de Medicina Interna, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria delHospital ClínicoSan Carlos (IdISSC),Madrid, Spain
b Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
Related content
A. Salinas-Botrán, J. Sanz-Cánovas, J. Pérez-Somarriba, L.M. Pérez-Belmonte, L. Cobos-Palacios, M. Rubio-Rivas, S. de-Cossío-Tejido, J.M. Ramos-Rincón, M. Méndez-Bailón, R. Gómez-Huelgas
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Dear Director,

We are grateful for the comments on our article “Clinical characteristics and risk factors for mortality upon admission in patients with heart failure hospitalized due to COVID-19 in Spain.”1 Indeed, glucocorticoid (GC) use was greater in patients with heart failure (HF) hospitalized for COVID-19 who died. This can be explained by the effects of the mineralocorticoid and sodium and water retention, as the letter’s authors correctly indicate.2

Unfortunately, we do not have specific data regarding the type of GC used; the only data recorded were whether they were used or not, the dose used, and the duration of treatment (SEMI-COVID-19 Registry).3 However, the following considerations should be noted:

First, the most used GC during the first wave of the epidemic in Spain was methylprednisolone, as a recent article indicated.4 Evidence on the reduction in mortality associated with the use of dexamethasone was not reported until later on5 and as such, it was used less in our country during the first wave.

Second, the initial multivariable analysis conducted in our study included patients’ baseline clinical variables at the time of admission and did not include variables regarding treatment administered. We are currently working on a larger, more focused database in order to discern the effect of treatment, including the use of GC (especially dexamethasone) on this profile of patient.

Lastly, and in contrast to the possible deleterious effect of GC in patients with HF, it should be noted that some recent works have demonstrated the utility of other drugs in patients with HF during hospitalization for COVID-19. Patients with HF who continued treatment with renin-angiotensin-aldosterone system inhibitors during hospitalization had lower in-hospital mortality rates than those who did not receive them or in whom they were suspended.6

In conclusion, according to our results, GC should be used with caution in patients with HF, weighing their risks and benefits. More prospective, controlled studies on the use of GC in patients with HF and COVID-19 are needed to confirm these results.

References
[1]
A. Salinas-Botrán, J. Sanz-Cánovas, J. Pérez-Somarriba, L.M. Pérez-Belmonte, L. Cobos-Palacios, M. Rubio-Rivas, et al.
Características clínicas y factores de riesgo de mortalidad al ingreso en pacientes con insuficiencia cardíaca hospitalizados por COVID-19 en España.
Rev Clin Esp, 222 (2022), pp. 255-265
[2]
C.S. Kow, D.S. Ramachandram, S.S. Hasan.
Tratamiento con glucocorticoides en pacientes con COVID-19 e insuficiencia cardíaca concurrente.
Rev Clin Esp, 222 (2022), pp. 309-310
[3]
J.M. Casas-Rojo, J.M. Antón-Santos, J. Millán-Núñez-Cortés, C. Lumbreras-Bermejo, J.M. Ramos-Rincón, E. Roy-Vallejo, et al.
Características clínicas de los pacientes hospitalizados con COVID-19 en España: resultados del Registro SEMI-COVID-19.
Rev Clin Esp, 220 (2020), pp. 480-494
[4]
L.M. Pérez-Belmonte, J. Sanz-Cánovas, A. Salinas, I. Sagastagoitia Fornie, M. Méndez-Bailón, R. Gómez-Huelgas, et al.
Corticosteroid therapy in patients with heart failure hospitalized for COVID-19: a multicenter retrospective study.
Intern Emerg Med, (2021), pp. 1-5
[5]
P. Horby, W.S. Lim, J.R. Emberson, M. Mafham, J.L. Bell, RECOVERY Collaborative Group.
Dexamethasone in hospitalized patients with Covid-19.
N Engl J Med, 384 (2021), pp. 693-704
[6]
L.M. Pérez-Belmonte, J. Sanz-Cánovas, A. Salinas, J.L. Garcia-Klepzig, M. Méndez-Bailón, R. Gómez-Huelgas.
Adverse outcomes in patients with heart failure admitted for COVID-19 in association with renin-angiotensin-aldosterone system inhibitors.
Pol Arch Intern Med, (2021),

Please cite this article as: Salinas-Botrán A, Pérez-Belmonte LM, Méndez-Bailón M. Respuesta a la carta «Tratamiento con glucocorticoides en pacientes con COVID-19 e insuficiencia cardíaca concurrente». Rev Clín Esp. 2022;222:311–312.

Copyright © 2021. Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)
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