J Med Virol. 2020 Oct 27. doi: 10.1002/jmv.26635. Online ahead of print.
INTRODUCTION: Corticosteroids reduces mortality in hospitalized patients with COVID-19, but the response seems to vary according to the level of respiratory support needed.
METHODS: This retrospective cohort study included COVID-19 patients with oxygen saturation (SatO2) in room air < 92% admitted between March 3 and April 30, 2020. Following the interim protocol, patients could receive dexamethasone or methylprednisolone, and were classified according to oxygen requirements. The primary endpoint was admission to Intensive Care Unit (ICU) or mortality. Kaplan-Meier and Cox hazards analyses were used.
RESULTS: Of the 115 patients included, 38 received corticosteroids. Among patients requiring high-flow, non-invasive ventilation (NIV) or fraction of inspired oxygen (FiO2) > 0.40, the HR for death or ICU admission, between corticosteroids and non-corticosteroids group, was 0.07 (95% CI 0.01-0.4), p= 0.002, and for patients requiring low-flow oxygen the HR was 070 (95% CI 0.13-3.8), p= 0.68. Significant differences were also observed when all patients were analyzed together.
CONCLUSION: A significant reduction in mortality and ICU admission frequency was observed among patients requiring high-flow oxygen or NIV, but not among those requiring low-flow oxygen. A better targeting of COVID-19 patients is needed for a beneficial use of corticosteroids. This article is protected by copyright. All rights reserved.