Clin Pharmacol Ther. 2021 Mar 31. doi: 10.1002/cpt.2245. Online ahead of print.
The most beneficial effect of corticosteroid therapy in COVID-19 patients has been shown in subjects receiving invasive mechanical ventilation (IMV), corresponding to a score of 6 on the WHO COVID-19 Ordinal Scale of Clinical Improvement (OSCI). Aim of this observational, single centre, prospective study was to assess the association between corticosteroids and hospital mortality in COVID-19 patients who did not receive IMV (OSCI 3-5). 1311 COVID-19 patients admitted to non-intensive care wards were included, and were divided in two cohorts: 1) 480 patients who received corticosteroid therapy 2) 831 patients who did not. The median daily dose was of 8 mg of dexamethasone or equivalent, with a mean therapy duration of 5 (3-9) days. The indication to administer or withhold corticosteroids was given by the treating physician. In-hospital mortality was similar between the two cohorts after adjusting for possible confounders.(ORadj 1·04, 95%CI 0·81-1·34, p=0·74). There was also no difference in Intensive Care Unit (ICU) admission (ORadj 0·81, 95% CI 0·56-1·17, p=0·26). COVID-19 patients with non-invasive mechanical ventilation (NIMV) had a lower risk for ICU admission if they received steroid therapy (ORadj 0·58, 95% CI 0·35-0·94, p=0·03). In conclusion, corticosteroids were overall not associated with a difference in hospital mortality for patients with COVID-19 with OSCI 3-5. In the subgroup of patients with NIMV (OSCI 5) corticosteroids reduced ICU admission, whereas the effect on mortality requires further studies.