Early Corticosteroids Decrease Mortality in Critically Ill Patients with COVID-19: A Cohort Study

Abstract

Background: Critically ill patients with coronavirus disease 19 (COVID-19) have a high fatality rate likely due to a dysregulated immune response. Corticosteroids could attenuate this inappropriate response, although there are still some concerns regarding its use, timing, and dose. Methods: This is a nationwide, prospective, multicenter, observational, cohort study in critically ill adult patients with COVID-19 admitted into Intensive Care Units (ICU) in Spain from March 12th to June 29th, 2020. Using a multivariable Cox model with inverse probability weighting, we compared relevant outcomes between patients treated with early corticosteroids (before or within the first 48h of ICU admission) with those who did not receive early corticosteroids or any corticosteroids at all. Primary endpoint was ICU mortality. Secondary endpoints included 7-day mortality, ventilator-free days, and complications. Results: A total of 691 patients out of 882 (78.3%) received corticosteroid during their hospital stay. Patients treated with early-corticosteroids (n=485) had a lower ICU mortality (30.3% vs 40.6%, HR 0.71, 95% CI 0.57-0.89) and higher number of ventilator-free days (mean difference 2.5 days, 95% CI 1.3-3.8) compared to non-early treated patients. There were no differences in 7-day mortality (HR 0.76, 95% CI 0.48-1.2), medical complications (OR 2.18, 95% CI 0.91-5.25) or secondary infections (OR 0.88, 95% CI 0.67-1.15) between both groups. Of note, early use of moderate-to-high doses was associated with better outcomes than low dose regimens. Conclusion: Early use of corticosteroids in critically ill patients with COVID-19 is associated with lower mortality (10.3% absolute risk reduction) and shorter duration of mechanical ventilation.

Tocilizumab, Remdesivir, Favipiravir, and Dexamethasone Repurposed for COVID-19: a Comprehensive Clinical and Pharmacovigilant Reassessment

“…Importantly, we would like to restress our previous agreement with the clinical recommendation against the routine use of glucocorticoids in the management of COVID-19 especially after important concerns were raised regarding the interpretation of data as well as the limitations of several studies showing potential benefit of glucocorticoids in COVID-19 [ 43 ]. Furthermore, patient characteristics were suggested to be assessed before prescribing corticosteroids to critical COVID-19 cases and a higher dose of corticosteroids administered to those patients was suggested to be more beneficial [ 44 ]. Thus, we recommend that for the patients’ best interests, a potential benefit from the RECOVERY dexamethasone as well as to assess its optimal dose and duration of administration in selected COVID-19 critical cases should be confirmed, or denied, by other well-designed and interpreted large randomized and controlled clinical trials [ 45 – 47 ].…”

When to call it off: Defining the role of low-dose corticosteroids in thwarting the progression of non-severe COVID-19

“…Similarly, in another study by Selvaraj et al steroid therapy has boasted potential by eliciting a 77.98% fall in peak CRP levels after the commencement of dexamethasone [ 13 ]. A study comparing outcomes between patients receiving early steroids upon ICU submission (n = 485), patients receiving delayed steroids (n = 206), and patients never receiving steroids (n = 191) has also yielded noteworthy results [ 14 ]. It was noted that patients who received early steroids had a lower mortality rate (30.3%) compared to those who received a delayed steroid treatment (44.2%) and those who never received steroids (36.6%) [ 14 ].…”

“…A study comparing outcomes between patients receiving early steroids upon ICU submission (n = 485), patients receiving delayed steroids (n = 206), and patients never receiving steroids (n = 191) has also yielded noteworthy results [ 14 ]. It was noted that patients who received early steroids had a lower mortality rate (30.3%) compared to those who received a delayed steroid treatment (44.2%) and those who never received steroids (36.6%) [ 14 ]. Similarly, the 7-day mortality was also lower in the early steroid group (7.2% vs 15.2% in the never group) [ 14 ].…”

“…It was noted that patients who received early steroids had a lower mortality rate (30.3%) compared to those who received a delayed steroid treatment (44.2%) and those who never received steroids (36.6%) [ 14 ]. Similarly, the 7-day mortality was also lower in the early steroid group (7.2% vs 15.2% in the never group) [ 14 ]. Secondary outcomes included more ventilator free days, shorter ICU stays, and a decrease in secondary infections [ 14 ].…”

“…Similarly, the 7-day mortality was also lower in the early steroid group (7.2% vs 15.2% in the never group) [ 14 ]. Secondary outcomes included more ventilator free days, shorter ICU stays, and a decrease in secondary infections [ 14 ].…”