Impact of Glucocorticoid Treatment in Sars-Cov-2 Infection Mortality: A Retrospective Controlled Cohort Study

Abstract

Objective: We aim to determine the impact of steroid use in COVID-19 pneumonia in-hospital mortality. Design: We performed a single-centre retrospective cohort study. Setting: A University hospital in Madrid, Spain, during March 2020. Participants: Patients admitted with SARS-CoV-2 pneumonia. Exposures: Patients treated with steroids were compared to patients not treated with steroids. A propensity-score for steroid treatment was developed. Different steroid regimens were also compared, and adjusted with a second propensity score. Main Outcomes and Measures: To determine the role of steroids in in-hospital mortality, univariable and multivariable analyses were performed, and adjusted including the propensity score as a covariate. Survival times were compared using a log-rank test. Results: During the study period, 463 out of 848 hospitalized patients with COVID19 pneumonia fulfilled inclusion criteria. Among them, 396 (46.7%) consecutive patients were treated with steroids and 67 patients were assigned to the control cohort. Global mortality was 15.1%. Median time to steroid treatment from symptom onset was 10 days (IQR 8 to13). In-hospital mortality was lower in patients treated with steroids than in controls (13.9% [55/396] versus 23.9% [16/67], OR 0.51 [0.27 to 0.96], p= 0.044). Steroid treatment reduced mortality by 41.8% relative to no steroid treatment (RRR 0,42 [0.048 to 0.65). Initial treatment with 1 mg/kg/day of methylprednisolone (or equivalent) versus steroid pulses was not associated with in-hospital mortality (13.5% [42/310] versus 15.1% [13/86], OR 0.880 [0.449-1.726], p=0.710). Conclusions: Our results show that survival of patients with SARS-CoV2 pneumonia is higher in patients treated with glucocorticoids than in those not treated. In-hospital mortality was not different between initial regimens of 1 mg/kg/day of methylprednisolone or equivalent and glucocorticoid pulses. These results support the use of glucocorticoids in SARS-CoV2 infection.

Immunosuppressive Drugs and COVID-19: A Review

“…Two of these studies found that patients treated with steroids had a lower prevalence of mechanical ventilation and shorter length of ICU and hospital stay than controls ( Fadel et al., 2020 ; Wang et al., 2020 ). In three other studies that only included COVID-19 patients with ARDS, the mortality rate was lower in patients treated with steroids than in controls ( Fernandez Cruz et al., 2020 ; Lu et al., 2020 ; Wu et al., 2020 ). In COVID-19 patients treated with tocilizumab, additional administration of steroids was also associated with a lower mortality rate ( Sanz Herrero et al., 2020 ).…”

“…Six retrospective cohort studies also found that the use of steroids was associated with beneficial outcomes in patients with COVID-19 ( Fadel et al., 2020 ; Fernandez Cruz et al., 2020 ; Lu et al., 2020 ; Sanz Herrero et al., 2020 ; Wang Y. et al., 2020 ; Wu et al., 2020 ). Two of these studies found that patients treated with steroids had a lower prevalence of mechanical ventilation and shorter length of ICU and hospital stay than controls ( Fadel et al., 2020 ; Wang et al., 2020 ).…”

Emerging treatment strategies for COVID-19 infection

“…A retrospective cohort analysis of patients with COVID-19 who developed ARDS (41.8% of patients) showed that treatment with methylprednisolone was associated with a decreased risk of death (HR 0.38; 95% CI 0.20–0.72) [ 80 ]. A single-center retrospective cohort study reported that hospitalized COVID-19 patients treated with steroids ( n = 396) had a lower mortality rate than those who did not receive steroids ( n = 67), 13.9% vs. 23.9% (HR 0.51, 95% CI 0.27–0.96, p = 0.044) [ 81 ]. The recently published Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial, an open label randomized controlled trial compering dexamethasone (6 mg daily for 10 days) versus standard of care, terminated enrollment early due to a mortality benefit with dexamethasone [ 82 ].…”

Corticosteroids in COVID-19: Is it Rational? A Systematic Review and Meta-Analysis

“…4). Sensitivity assessment done after excluding a study with significantly high weight (Cruz AF 2020 [25]) showed significant odds for getting corticosteroids among ARDS (OR 5.64, 95% CI 2.02 to 15.70) (Additional file 4/ Fig. 5).…”