Do High Dose Corticosteroids Improve Outcomes in Hospitalized COVID-19 Patients?

Abstract

PROBLEM\nCOVID-19 is characterized by dysregulated hyperimmune response and steroids have been shown to decrease mortality. However, whether higher dosing of steroids results in better outcomes have been debated.\n\n\nMETHODS\nThis was a retrospective observational of COVID-19 admissions between March 1st 2020 and March 10th 2021. Adult patients (≥18 years) who received more than 10mg daily methylprednisolone equivalent dosing (MED) within first 14 days. We excluded patients who were discharged or died within 7 days of admission. We compared standard dose of steroids (<40mg MED) versus high dose of steroids (>40mg MED). Inverse probability weighted regression adjustment was used to examine whether higher dose steroids resulted in improved outcomes. The outcomes studied were in hospital mortality, rate of acute kidney injury (AKI) requiring hemodialysis, invasive mechanical ventilation (IMV), hospital associated infections (HAI) and readmissions.\n\n\nMAIN RESULTS\nOf the 1379 patients meeting study criteria, 506 received < 40mg of MED (median dose 30mg MED) and 873 received ≥40mg of MED (median dose 78mg MED). Unadjusted in-hospital mortality was higher in patients who received high dose corticosteroids (40.7% vs 18.6%, p<0.001). On IPWRA, use of high dose corticosteroids was associated with higher odds of death (OR 2.14; 95%CI 1.45-3.14, p<0.001) but not with development of HAI, readmissions, or requirement of invasive mechanical ventilation. High dose corticosteroids were associated with lower rates of AKI requiring hemodialysis (OR 0.33; 95% CI 0.18-0.63).\n\n\nCONCLUSIONS\nIn COVID-19, Corticosteroids ≥40mg MED were associated with higher in hospital mortality. This article is protected by copyright. All rights reserved.