Efficacy of corticosteroids in non-intensive care unit patients with COVID-19 pneumonia from the New York Metropolitan region

Abstract

Introduction The role of systemic corticosteroid as a therapeutic agent for patients with COVID-19 pneumonia is controversial. Objective The purpose of this study was to evaluate the effect of corticosteroids in non-intensive care unit (ICU) patients with COVID-19 pneumonia complicated by acute hypoxemic respiratory failure (AHRF). Methods This was a single-center retrospective cohort study, from 16 th March, 2020 to 30 th April, 2020; final follow-up on 10 th May, 2020. 265 patients consecutively admitted to the non-ICU wards with laboratory-confirmed COVID-19 pneumonia were screened for inclusion. 205 patients who developed AHRF (SpO 2 /FiO 2 � 440 or PaO 2 /FiO 2 � 300) were only included in the final study. Direct admission to the Intensive care unit (ICU), patients developing composite primary outcome within 24 hours of admission, and patients who never became hypoxic during their stay in the hospital were excluded. Patients were divided into two cohorts based on corticosteroid. The primary outcome was a composite of ICU transfer, intubation, or in-hospital mortality. Secondary outcomes were ICU transfer, intubation, in-hospital mortality, discharge, length of stay, and daily trend of SpO 2 /FiO 2 (SF) ratio from the index date. Cox-proportional hazard regression was implemented to analyze the time to event outcomes.

Corticosteroids for COVID-19 Therapy: Potential Implications on Tuberculosis

“…However, the analysis indicated a bias due to routine CST use in the usual care group, and lack of their elimination during screening should be considered [ 40 ]. Studies show the beneficial effects of smaller doses of systemic CSTs administration for a short duration or pulse CST therapy; however, other confounders should be considered before starting the treatment [ 41 , 42 ]. Notably, the pooled estimates of CST therapy benefits were similar between COVID-19 and non-COVID-19 associated ARDS, and there is more than 15% reduced mortality [ 43 ].…”

Early hydroxychloroquine but not chloroquine use reduces ICU admission in COVID-19 patients

“…It is conceivable that the beneficial effect of early HCQ in COVID-19 lies in the reduction of localized inflammation in the lung. This is supported by the results of a recent observational study, which indicated that the use of moderate-dose systemic corticosteroids on the general ward lowered the hazard of ICU transfer (Majmundar et al, 2020).…”

Revised Korean Society of Infectious Diseases/National Evidence-based Healthcarea Collaborating Agency Guidelines on the Treatment of Patients with COVID-19

“…The 28-day mortality was not improved; however, in subgroup analysis of those over the age of 60, the mortality rate was significantly lower in the high-dose methylprednisolone group than in the control group (46.6% vs. 61.9%) [ 124 ]. In three observational studies including various patient groups, type of steroid, and duration of administration, steroid administration improved the mortality rate, ICU transfer rate, and airway intubation index [ 125 126 127 ]. However, in a retrospective cohort study of COVID-19 patients with mild pneumonia, short-term administration of low-dose steroid for 3 – 5 days was associated with clinical deterioration [ 128 ].…”