Effect of Corticosteroids on Mortality in Hospitalized COVID-19 Patients Not Receiving Invasive Mechanical Ventilation

© 2021 The Authors. Clinical Pharmacology & Therapeutics © 2021 American Society for Clinical Pharmacology and Therapeutics..

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 World Health Organization (WHO) COVID-19 Ordinal Scale for Clinical Improvement (OSCI). The aim of this observational, single-center, prospective study was to assess the association between corticosteroids and hospital mortality in coronavirus disease 2019 (COVID-19) patients who did not receive IMV (OSCI 3-5). Included were 1,311 COVID-19 patients admitted to nonintensive care wards, and they were divided in two cohorts: (i) 480 patients who received corticosteroid therapy and (ii) 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 (adjusted odds ratio (ORadj) 1.04, 95% confidence interval (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 noninvasive 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.

Media Type:

Electronic Article

Year of Publication:

2021

Contained In:

Clinical pharmacology and therapeutics - Vol. 109, No. 6 (2021), p. 1660-1667

Language:

English

Contributors:

Fusina, Federica
Albani, Filippo
Granato, Enza
Meloni, Angelo
Rozzini, Renzo
Sabatini, Tony
Stellini, Roberto
Terragnoli, Paolo
Rosano, Antonio
Abu Hilal, Mohammed
Natalini, Giuseppe

Urls:

Volltext

Keywords:

Adrenal Cortex Hormones
Aged
Aged, 80 and over
COVID-19
Female
Hospital Mortality
Humans
Intensive Care Units
Journal Article
Male
Middle Aged
Observational Study
Prospective Studies
Respiration, Artificial
Retrospective Studies
SARS-CoV-2
Sex Factors

Notes:

Date Completed 09.06.2021

Date Revised 09.06.2021

published: Print-Electronic

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1002/cpt.2245

PMID:

33792037

PPN (Catalogue-ID):

NLM324566522