Impact of Systemic Corticosteroids on Mortality in Older Adults With Critical COVID-19 Pneumonia

Abstract

Background The most susceptible population group to critical and fatal coronavirus disease 2019 (COVID-19) is older adults. In SARS-CoV-2 infection, the host immune response is thought to play a key role in the pathophysiological effects of lung damage. Therefore, corticosteroid therapy could modulate inflammation-mediated pulmonary injury and thereby reduce progression to severe respiratory failure and death. The aim of this study was to analyse the safety and clinical efficacy of corticosteroid therapy in older adults with severe COVID-19 pneumonia. Method We reviewed the clinical records of confirmed COVID-19 patients aged 75 years or older admitted to our hospital over a three months period (March 1, to May 31, 2020). A total of 143 patients were included in the study cohort. From 2 April, 2020, in accordance with World Health Organization (WHO) guidance on COVID-19, our hospital protocol added corticosteroid for COVID-19 treatment. We compared in-hospital mortality among patients with critical COVID-19 who received corticosteroids therapy and those who did not. Results 88 patients (61.5%) were treated with corticosteroids, and 55 patients (38.4%) were not. Both groups were similar in baseline characteristics. The median age was 85 years (IQR, 82–89), and 61.5% (88/143) were male. In-hospital mortality was lower in the corticosteroid group (68.2%) compared with patients in the non-corticosteroid group (81.8%). Treatment with corticosteroids was an independent survival factor (HR=0.61; 95% CI, 0.41–0.93; P=0.006). Conclusions In critically ill older adults with COVID-19 pneumonia, the use of corticosteroid treatment resulted in lower mortality without severe adverse events.

The roles of methylprednisolone treatment in patients with COVID-19: A systematic review and meta-analysis

“…After reviewing, 47 articles were removed for the following reasons: intervention group involved other agents (n = 16), non-comparative studies (n = 13), data cannot be extracted (n = 11), comparison between different glucocorticoids (n = 4), and duplicate data (n = 3). Finally, 5 RCTs [14] , [16] , [26] , [36] , [37] and 28 non-RCTs [13] , [15] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] met the criteria for inclusion in the meta-analysis. A flow diagram that describes the search process is shown in Fig.…”

“…The number of single-center and multicenter studies was 23 and 10, respectively. Most studies were conducted in China (n = 16) [18] , [20] , [22] , [24] , [25] , [28] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , followed by the United States (n = 5) [17] , [27] , [30] , [31] , [33] , Spain (n = 5) [14] , [15] , [19] , [32] , [35] , Italy (n = 3) [21] , [29] , [34] , the United Arab Emirates (n = 2) [21] , [29] , [34] , Brazil (n = 1) [26] and Iran (n = 1) [16] . The study interval in each study ranged from 1 January 2020 to 31 July 2020.…”

“…In our analysis, there were 29 studies [13] , [14] , [15] , [16] , [17] , [19] , [20] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [42] , [43] , [45] providing the information regarding short-term mortality. After pooling data, short-term mortality was seen in 468 (21.8 %) of 2146 patients receiving methylprednisolone and 496 (24.8 %) of 1996 receiving no glucocorticoids treatment.…”

“…There were 15 studies [13] , [15] , [16] , [17] , [23] , [24] , [25] , [32] , [35] , [37] , [39] , [41] , [43] , [44] , [45] reporting the date with regard to hospital stay. Due to a significant heterogeneity across studies ( p < 0.001), random effects model was used.…”

“…It is well established that the preferred glucocorticoid for the treatment of ARDS in ICU is methylprednisolone rather than dexamethasone. Since the outbreak of epidemic, there have been many studies on methylprednisolone treatment in patients with COVID-19 [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , but the results are inconsistent.…”