Efficacy of Corticosteroids in Non-Intensive Care Unit Patients with COVID-19 Pneumonia from the New York Metropolitan region

Abstract

<jats:p>Introduction: The role of systemic corticosteroid as a therapeutic agent for patients with COVID 19 pneumonia is controversial. Objective: The purpose of this study was to evaluate the effect of corticosteroids in non-intensive care unit (ICU) patients with COVID 19 pneumonia complicated by acute hypoxemic respiratory failure (AHRF). Methods: This was a single-center retrospective cohort study, from the 16th March, 2020 to 30th April, 2020; final follow up on 10th May, 2020. 265 patients consecutively admitted to the non ICU wards with laboratory confirmed COVID 19 pneumonia were screened for inclusion. 205 patients who developed AHRF (SpO2/FiO2 &lt;= 440 or PaO2/FiO2 &lt;= 300) were only included in the final study. Direct admission to the Intensive care unit (ICU), patients developing composite primary outcome within 24 hours of admission, and patients who never became hypoxic during their stay in the hospital were excluded. Patients divided into two cohort based on corticosteroid. The primary outcome was a composite of ICU transfer, intubation, or in-hospital mortality. Secondary outcomes were ICU transfer, intubation, in hospital mortality, discharge, length of stay, and daily trend of SpO2/FiO2 (SF) ratio from the index date. Cox proportional hazard regression was implemented to analyze the time to event outcomes. Result: Among 205 patients, 60 (29.27%) were treated with corticosteroid. The mean age was ~57 years, and ~75% were men. Thirteen patients (22.41%) developed a primary composite outcome in the corticosteroid cohort vs. 54 (37.5%) patients in the non-corticosteroid cohort (P=0.039). The adjusted hazard ratio (HR) for the development of the composite primary outcome was 0.15 (95% CI, 0.07 to 0.33; P &lt;0.001). The adjusted hazard ratio for ICU transfer was 0.16 (95% CI, 0.07 to 0.34; P &lt; 0.001), intubation was 0.31 (95% CI, 0.14 to 0.70; P= 0.005), death was 0.53 (95% CI, 0.22 to 1.31; P = 0.172), and discharge was 3.65 (95% CI, 2.20 to 6.06; P&lt;0.001). The corticosteroid cohort had increasing SpO2/FiO2 over time compared to the non-corticosteroid cohort who experience decreasing SpO2/FiO2 over time. Conclusion: Among non ICU patients hospitalized with COVID 19 pneumonia complicated by AHRF, treatment with corticosteroid was associated with a significantly lower risk of the primary composite outcome of ICU transfer, intubation, or in hospital death.</jats:p>

Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline (updated version)

“…A retrospective cohort study based on propensity score analysis (n = 132 non-severe COVID-19 patients, matching 35 for corticosteroid group-initial MP dosage 40 mg/ d for 8-12 days, and 35 for control group) found that in corticosteroid group, the hospital stay and duration of viral shedding were prolonged, while fever time was shortened, however all these data had no statistically significant differences, and it did not report any adverse effect [90].…”

Corticosteroid use in COVID-19 patients: A systematic review and meta-analysis on clinical outcomes

“…In 29 studies the dose of corticosteroids was reported: In 16 studies an equivalent dose of > 1 mg/kg prednisolone was used [37][38][39]41,43,44,[48][49][50][51]53,54,[56][57][58]64] and in 11 studies a lower equivalent dose than 1 mg/kg prednisolone [23,[34][35][36]40,42,47,52,62,63,65]. In two studies a low and high dose group were present [45,46].…”

“…In twelve studies length of hospital stay was compared in both corticosteroid and non-corticosteroid groups. The outcomes varied between studies: six reported longer hospital stay in the corticosteroid group [36,47,53,56,66] and ve reported the opposite [23,34,38,52,54] or no effect on hospital stay [58].…”

“…Fourteen of 17 studies reported a positive effect of corticosteroids on ventilator free days [34,37,56], on the number of patient requiring mechanical ventilation for respiratory insu ciency [23,35,38,48,54,57,58,60,68,72] or on the time on ventilator [52]. In the pooled analyses fewer patients required mechanical ventilation in the corticosteroids group (RR 0.71 (95%CI 0.54-0.97) ( Figure 3) though only seven studies supplied su cient data for this analysis.…”

“…The effect of corticosteroids on oxygenation was very heterogeneous: In four studies there was no signi cant effect [41,42,51,55], in three studies signi cant improvement was described [50,60,64] and in four studies worse outcome was observed. [35,39,54,57] Six studies addressed secondary infections. More frequently broad spectrum antibiotics were used in de corticosteroid group [39,47,53] and more secondary infections/sepsis episodes were described [35,36].…”