Effectiveness of glucocorticoids in patients hospitalized for severe SARS-CoV-2 pneumonia

Abstract

Background Several studies have reported the beneficial effect of glucocorticoids in the treatment of cytokine storm that occurs in patients with severe COVID-19. Various glucocorticoids regimens have been proposed. Methods Retrospective observational study that includes patients with severe SARS-CoV-2 pneumonia and compares admission to an Intensive Care Unit (ICU) or death during hospitalization in three groups of patients: no glucocorticoids treatment, use of glucocorticoids doses equivalent to less than 250 mg of prednisone daily and use of equivalent doses greater than or equal to 250 mg of prednisone daily. Multivariate analysis was performed using logistic regression, using the propensity index as a covariant. Results Of the 259 patients enrolled in the study, 67 (25.9%) had an unfavorable evolution, dying or requiring ICU admission. Comparative analyzes between different glucocorticoids treatments and the association with ICU admission or death were: glucocorticoids treatment (any dose) versus no glucocorticoids treatment (OR: 0.71 (0.30-1.66)), treatment with glucocorticoids (≥ 250 mg prednisone daily) versus no glucocorticoids treatment (OR: 0.35 (0.11-1.08)) and glucocorticoids treatment (≥ 250 mg prednisone daily) versus patients with glucocorticoids doses <250 mg prednisone daily or without glucocorticoids treatment (OR: 0.30 (0.10-0.88)). Conclusion The results of this study show that patients with severe SARS-CoV-2 pneumonia treated with glucocorticoids pulses with equivalent doses of prednisone greater than or equal to 250 mg have a more favorable evolution (less mortality and less admission to ICU).

Efficacy and Safety of Corticosteroid Use in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis

“…There were 11 RCTs [ 11 – 14 , 23 – 26 ] (DEXA-COVID 19, NCT04325061; COVID STEROID, NCT04348305; Steroids-SARI, NCT04244591) and 44 OSs [ 21 , 22 , 27 – 68 ] that reported an association between mortality and corticosteroid therapy in patients with COVID-19. There were only one RCT [ 23 ] and eight OSs [ 33 , 34 , 46 , 49 , 55 – 58 ] that used pulse dose of corticosteroid. The OSs were included to further explore the corticosteroid type and pulse dose duration that were beneficial to patients with COVID-19.…”