Effect of Systemic Glucocorticoids on Mortality or Mechanical Ventilation in Patients With COVID-19

Abstract

The efficacy of glucocorticoids in COVID-19 is unclear. This study was designed to determine whether systemic glucocorticoid treatment in COVID-19 patients is associated with reduced mortality or mechanical ventilation. This observational study included 1,806 hospitalized COVID-19 patients; 140 were treated with glucocorticoids within 48 hours of admission. Early use of glucocorticoids was not associated with mortality or mechanical ventilation. However, glucocorticoid treatment of patients with initial C-reactive protein (CRP) ≥20 mg/dL was associated with significantly reduced risk of mortality or mechanical ventilation (odds ratio, 0.23; 95% CI, 0.08- 0.70), while glucocorticoid treatment of patients with CRP <10 mg/dL was associated with significantly increased risk of mortality or mechanical ventilation (OR, 2.64; 95% CI, 1.39-5.03). Whether glucocorticoid treatment is associated with changes in mortality or mechanical ventilation in patients with high or low CRP needs study in prospective, randomized clinical trials. Journal of Hospital Medicine 2020;15:XXX-XXX. © 2020 Society of Hospital Medicine

Influenza infection, SARS, MERS and COVID-19: Cytokine storm – The common denominator and the lessons to be learned

“…This question requires further research but some data have already been published. In particular, glucocorticoid treatment of hospitalized patients with COVID-19 who had CRP ≥20 mg/dL at admission was associated with significantly reduced risk of mortality or mechanical ventilation (odds ratio, 0.23; 95% CI, 0.08–0.70), while glucocorticoid treatment of patients with CRP <10 mg/dL was associated with significantly increased risk of mortality or mechanical ventilation (OR, 2.64; 95% CI, 1.39–5.03) [ 86 ]. Probably, similar cutoff for CRP at admission can be chosen for the trial of corticosteroids in other respiratory viral infections with presumptive cytokine storm syndrome.…”

Potential Therapeutic Options for COVID-19: Current Status, Challenges, and Future Perspectives

“…Observational studies in patients with SARS and MERS did not report any association between corticosteroid use and increased survival (Arabi et al, 2018), but showed an association of their use with delayed viral clearance in the respiratory tract and blood and the high frequency of complications, including hyperglycemia and psychosis (Keller et al, 2020).…”

A review of potential suggested drugs for coronavirus disease (COVID-19) treatment

“…Corticosteroid therapy in patients with initial C-reactive protein (CRP) 20 mg/dL or more significantly decreased mortality or mechanical ventilation. In contrast, mortality or mechanical ventilation became more significant in patients with a CRP level of less than 10 mg/dL ( Keller et al, 2020 ).…”