Effects of early corticosteroid use in patients with severe coronavirus disease 2019

Abstract

Background Coronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents for this disease. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes. Methods This was a retrospective cohort study including patients with severe COVID-19 who received corticosteroid treatment from March 2 to June 30, 2020 in seven tertiary hospitals in South Korea. We analyzed the patient demographics, characteristics, and clinical outcomes according to the timing of steroid use. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids. Results Of the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10 days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO2/FiO2 ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08 days and the treatment duration was 14 days in the early use group, while those in the late use group were 12.80 days and 18.50 days, respectively. The PaO2/FiO2 ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4 days vs. 60.0 days, P = 0.030), time from diagnosis to discharge (27.8 days vs. 57.4 days, P = 0.024), and hospital stay (26.0 days vs. 53.9 days, P = 0.033) were shortened. Conclusions Among patients with severe COVID-19, early use of corticosteroids showed favorable clinical outcomes which were related to a reduction in the length of hospital stay.

Comparison of Low-Versus High-Dose Steroids in the Clinical Outcome of Hospitalized COVID-19 Patients

“…The overall case fatality rate in this study was 16.9%, while it was higher, 25%, in a study by Hyun J. et al [ 20 ] and a study by Docherty A et al quotes 32% ICU mortality [ 21 ]. Among the subgroups, the mortality rate was higher in patients receiving Methylprednisolone 9.9% than those who received Dexamethasone in either dose 3% (low dose) and 3.9% (high dose).…”

Implementation of the Abbott ID Now COVID-19 assay at a tertiary care center: a prospective pragmatic implementation study during the third wave of SARS-CoV-2 in Ontario

“…It is unclear if the high sensitivity seen in our study would hold up in outpatients, or if it will remain the same as rates of vaccination increase. Finally, while it can be hypothesized that faster initiation of COVID-19-specific active and supportive care may positively impact outcomes ( Hyun et al, 2021 ), a larger case control study would be required to clearly establish the presence or absence of clinical benefits.…”

Treatment with Fluticasone Propionate Increases Antibiotic Efficacy during Treatment of Late-Stage Primary Pneumonic Plague

“…The COVID-19 pandemic has emphasized the potential of corticosteroid use in severe pneumonia. Several clinical studies have been conducted concerning the use of intravenous corticosteroids, such as dexamethasone ( 39 – 42 ), methylprednisolone ( 40 – 44 ), and hydrocortisone ( 42 , 45 ), as adjunctive COVID-19 treatment. In some cases, these treatments have been shown to reduce COVID-19 symptoms and patient mortality, but variabilities between studies have made making decisive conclusions regarding corticosteroid use difficult ( 42 , 46 – 49 ).…”