Efficacy Evaluation of Early, Low-Dose, Short-Term Corticosteroids in Adults Hospitalized with Non-Severe COVID-19 Pneumonia: A Retrospective Cohort Study

Abstract

Objectives: This study aimed to observe the efficacy of corticosteroids in non-severe COVID-19 pneumonia. Methods: A retrospective study based on propensity score matching was designed to explore the effects of corticosteroids. Primary outcomes included the rate of patients who developed severe disease and mortality. Secondary outcomes included duration of fever, virus clearance time, length of hospital stay, and the use of antibiotics. Results: A total of 475 patients with non-severe COVID-19 pneumonia were enrolled, 55 patients received early, low-dose, and shortterm corticosteroids therapy, 420 patients received non-corticosteroids therapy. Compared to the non-corticosteroids group, there was a prolonged duration of fever (median 5 vs 3 days, p \ 0.001), virus clearance time (median 18 vs 11 days, p \ 0.001), and length of hospital stay (median 23 vs 15 days, p \ 0.001) in the corticosteroids group. The percentages of antibiotics therapy (89.1% vs 23.6%, p \ 0.001), use of at least two antibiotics (38.2% vs 12.7%, p = 0.002), and antifungal therapy (7.3% vs 0, p = 0.042) were higher in the corticosteroids group than those in the non-corticosteroids group. Compared to the non-corticosteroids group, more patients developed severe disease (12.7% vs 1.8%, p = 0.028) in the corticosteroids group. There was no significant difference between the two groups in mortality (1.8% vs 0, p = 0.315). Conclusion: In adult patients with non-severe COVID-19 pneumonia, early, low-dose, and short-term corticosteroids therapy was associated with worse clinical outcomes.

A systematic review of corticosteroid treatment for noncritically ill patients with COVID-19

“…We found some additional evidence to support the WHO recommendations that corticosteroid treatment is not recommended for mild or moderate patients with COVID-19 in terms of mortality and other clinical outcomes [15][16][17] . As for severe cases requiring oxygen without mechanical ventilation (severe but noncritical), no evidence was found besides the results of the RECOVERY trial 14,18 .…”

“…The effect of corticosteroid treatment on other clinical outcomes. One RCT, the RECOVERY trial, and four controlled observational studies using PSM (368 mild or moderate cases 16 and 607 moderate cases 15,17 , as defined by the CNHC, and 70 patients not requiring mechanical ventilation on admission and requiring more than 3 L/min of oxygen during hospitalization to reach saturation above 93%) 18 assessed the Table 4. The RECOVERY trial demonstrated that the number of patients who progressed to invasive mechanical ventilation in the dexamethasone group was significantly lower than that in the usual care group 3 .…”

“…This systematic review included one RCT, the RECOVERY trial 3 , and five controlled observational studies using PSM [14][15][16][17][18] , which assessed the association between corticosteroid treatment and any type of mortality and/ or other clinical outcomes among noncritically ill patients with COVID-19. Most of the results of controlled observational studies are consistent with those in the RECOVERY trial, principally contributing to the WHO recommendations issued on September 2, 2020.…”

Status of Novel Coronavirus Disease 2019 (COVID-19) and Animal Production

“…Based on positive results, dexamethasone has been authorized by the UK government for the treatment of critically ill COVID-19 patients (53). However, the comorbidity factors (especially diabetes) should be considered before treatment because some researchers reported that dexamethasone increases the risk of COVID-19 progression to severe disease, especially in patients with diabetes (54,55).…”

A review of potential suggested drugs for coronavirus disease (COVID-19) treatment

“…Antimicrobial therapy was more remarkable in the corticosteroid group. So worse outcomes are expected from corticosteroid therapy in non-severe COVID-19 pneumonia ( Li et al, 2020 ).…”