Corticosteroid treatment has no effect on hospital mortality in COVID-19 patients

Abstract

Since the start of the novel coronavirus 2019 (COVID-19) pandemic, corticosteroid use has been the subject of debate. The available evidence is uncertain, and knowledge on the subject is evolving. The aim of our cohort study was to evaluate the association between corticosteroid therapy and hospital mortality, in patients hospitalized with COVID-19 after balancing for possible confounders. One thousand four hundred forty four patients were admitted to our hospital with a positive RT-PCR test for SARS-CoV-2, 559 patients (39%) were exposed to corticosteroids during hospital stay, 844 (61%) were not exposed to corticosteroids. In the cohort of patients exposed to corticosteroids, 171 (30.6%) died. In the cohort of patients not exposed to corticosteroids, 183 (21.7%) died (unadjusted p < 0.001). Nonetheless, exposure to corticosteroids was not associated with in-hospital mortality after balancing with overlap weight propensity score (adjusted p = 0.25). Patients in the corticosteroids cohort had a reduced risk of ICU admission (adjusted p < 0.001). Treatment with corticosteroids did not affect hospital mortality in patients with COVID-19 after balancing for confounders. A possible advantage of corticosteroid therapy was to reduce Intensive Care Unit admission, which could be useful in reducing pressure on Intensive Care Units in times of limited resources, as during the COVID-19 pandemic.

Efficacy and Safety of Corticosteroid Use in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis

“…There were 11 RCTs [ 11 – 14 , 23 – 26 ] (DEXA-COVID 19, NCT04325061; COVID STEROID, NCT04348305; Steroids-SARI, NCT04244591) and 44 OSs [ 21 , 22 , 27 – 68 ] that reported an association between mortality and corticosteroid therapy in patients with COVID-19. There were only one RCT [ 23 ] and eight OSs [ 33 , 34 , 46 , 49 , 55 – 58 ] that used pulse dose of corticosteroid.…”

COVID-19 pneumonia in Galicia (Spain): Impact of prognostic factors and therapies on mortality and need for mechanical ventilation

“…The results of three meta-analysis further support the employ of systemic corticosteroids in COVID-19 pneumonia, but it is worth to mention that the weight of RECOVERY PLOS ONE trial was more than 50 per cent in all of them and the magnitude of the effect was modest (OR ranging from 0.70 to 0.88) [41][42][43]. On the other hand, several propensity score matching (PSM) studies found no impact of corticosteroids on COVID-19 pneumonia outcome [44][45][46][47][48][49], while an increased mortality was observed in other report [50] and two additional PSM studies concluded that corticosteroid therapy was associated with lower mortality [51,52]. Therefore, considering all the available evidence, the role of corticosteroids remains controversial in non-critically ill patients who need supplemental oxygen.…”

An Overview of the Epidemiologic, Diagnostic and Treatment Approaches of COVID-19: What do We Know?

“…According to a meta-analysis of COVID-19 patients, mortality was higher among patients receiving corticosteroids than among patients who were not receiving corticosteroids [ 113 ]. In contrast, a cohort study of 1444 COVID-19 patients found that treating with corticosteroids had no effect on hospital mortality [ 114 ]. As a result, corticosteroids seem to be a double-edged sword in the battle against COVID-19 and should be used cautiously, considering the risk–benefit ratio [ 115 ].…”