Role of systemic corticosteroids in preventing hypoxia among patients with mild COVID-19: An observational study

Abstract

COVID-19, corticosteroids, hypoxia, prolonged feverUse of systemic corticosteroids is well-established in COVID-19 patients with hypoxia; however, there is scant data on its role in patients with mild disease and prolonged symptoms as a measure to prevent disease progression. The aim of this study is to evaluate the role of systemic corticosteroids in preventing hypoxia (SpO 2 ≤ 93% on room-air) among mild COVID-19 patients. An observational study was conducted among symptomatic COVID-19 patients taking oral corticosteroids and attending institute teleconsultation facility between 10th-30th June 2021. Patients who were already on corticosteroids for other indication or required oxygen supplementation before or within 24-hours of initiation of corticosteroids were excluded. A total of 140 consecutive symptomatic COVID-19 patients were included. Higher baseline C-reactive protein (OR: 1.03, 95% CI: 1.02-1.06, p < 0.001) and early systemic corticosteroid (within 7 days) initiation (OR: 6.5, 95% CI: 2.1-20.1, p = 0.001) were independent risk factors for developing hypoxia (SpO 2 ≤ 93%). Progression to hypoxia was significantly higher in patients who received corticosteroids before day 7 of illness (36.7%, 95% CI, 23.4-51.7%) compared to ≥ 7 of illness (14.3%, 95% CI, 7.8-23.2%) for persistent fever. Systemic corticosteroids within 7 days from symptom-onset were harmful and increased the risk of progression to hypoxia, whereas it may decrease the risk of progression when administered on or beyond 7 days in patients with mild COVID-19 and persistent symptoms. A well-designed randomised controlled trial is required to validate the findings.among severe COVID-19 patients: a systematic review and meta-analysis of randomized controlled trials. Signal

Effect of corticosteroids in patients with COVID-19 early stage pneumonia and risk of disease progression: An uncharted territory

“…Hence, it is possible that the benefit of glucocorticoids in this subgroup of patients was underestimated. In accordance with this hypothesis, in the previously mentioned study by Aggarwal et al (6), the risk of developing hypoxia was higher in patients with a high C-reactive protein (OR: 1.03, 95% CI: 1.02-1.06, p < 0.001). However, the analysis might be limited by a small sample size.…”

“…Although current COVID-19 Treatment Guidelines do not recommend the use of corticosteroids in patients without oxygen needs (3)(4)(5), the optimal timing for initiating corticosteroids in hospitalized COVID-19 patients remains unclear. Therefore, we read with interest the recent study by Aggarwal et al (6) in Drug Discoveries & Therapeutics.…”

Home as the new frontier for the treatment of COVID-19: the case for anti-inflammatory agents

“…Anecdotal evidence from case reports and observational studies suggests that early outpatient treatment with systemic corticosteroids at the time of viral replication (ie, within the first few days of symptoms onset) is associated with an increased risk of delayed recovery and worse clinical outcomes. [125][126][127][128][129] Systemic corticosteroids cause widespread immunosuppression, which could be useful during the late inflammatory phase of severe COVID-19 but cause harm in the early disease phase by suppressing host antiviral responses. 130 Nonetheless, further studies are needed to pinpoint the optimal timing of corticosteroid initiation during the disease course.…”

The relationship between cumulative dose of immunosuppressive agents and COVID‐19‐associated mucormycosis: A multicenter cross‐sectional study

“…Another important point is the type of drug used to suppress the immune system. In our study, all people who received immunosuppressive therapy took dexamethasone as a corticosteroid, which could be due to its lower cost, availability, and better efficacy 14 . As the drug shortage, only five people received tocilizumab along with dexamethasone.…”