High versus standard doses of corticosteroids in severe COVID-19: a retrospective cohort study

• Published in: European journal of clinical microbiology & infectious diseases Vol. 40; no. 4; pp. 761 - 769
• Main Authors: Monreal, Enric, Sainz de la Maza, Susana, Natera-Villalba, Elena, Beltrán-Corbellini, Álvaro, Rodríguez-Jorge, Fernando, Fernández-Velasco, Jose Ignacio, Walo-Delgado, Paulette, Muriel, Alfonso, Zamora, Javier, Alonso-Canovas, Araceli, Fortún, Jesús, Manzano, Luis, Montero-Errasquín, Beatriz, Costa-Frossard, Lucienne, Masjuan, Jaime, Villar, Luisa María
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2021; Springer Nature B.V
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Biomedical and Life Sciences; Biomedicine; Cohort analysis; Cohort Studies; Coronaviruses; Corticoids; Corticosteroids; COVID-19; COVID-19 - complications; COVID-19 - drug therapy; COVID-19 - mortality; Dose-Response Relationship, Drug; Drug dosages; Female; Glucocorticoids - administration & dosage; Humans; Immune response; Internal Medicine; Logistic Models; Male; Mechanical ventilation; Medical Microbiology; Methylprednisolone; Methylprednisolone - administration & dosage; Middle Aged; Mortality; Original; Original Article; Respiration, Artificial - statistics & numerical data; Respiratory distress syndrome; Respiratory Distress Syndrome - epidemiology; Respiratory Distress Syndrome - etiology; Retrospective Studies; Risk; SARS-CoV-2; Severity of Illness Index; Steroid hormones; Steroids; Viral diseases; COVID-19; Severe acute respiratory syndrome coronavirus 2; SARS-CoV-2; Corticosteroids
• ISSN: 0934-9723; 1435-4373; 1435-4373
• DOI: 10.1007/s10096-020-04078-1

Despite the increasing evidence of the benefit of corticosteroids for the treatment of moderate-severe coronavirus disease 2019 (COVID-19) patients, no data are available about the potential role of high doses of steroids for these patients. We evaluated the mortality, the risk of need for mechanical ventilation (MV), or death and the risk of developing a severe acute respiratory distress syndrome (ARDS) between high (HD) and standard doses (SD) among patients with a severe COVID-19. All consecutive confirmed COVID-19 patients admitted to a single center were selected, including those treated with steroids and an ARDS. Patients were allocated to the HD (≥ 250 mg/day of methylprednisolone) of corticosteroids or the SD (≤ 1.5 mg/kg/day of methylprednisolone) at discretion of treating physician. Five hundred seventy-three patients were included: 428 (74.7%) men, with a median (IQR) age of 64 (54–73) years. In the HD group, a worse baseline respiratory situation was observed and male gender, older age, and comorbidities were significantly more common. After adjusting by baseline characteristics, HDs were associated with a higher mortality than SD (adjusted OR 2.46, 95% CI 1.59–3.81, p  < 0.001) and with an increased risk of needing MV or death (adjusted OR 2.35, p  = 0.001). Conversely, the risk of developing a severe ARDS was similar between groups. Interaction analysis showed that HD increased mortality exclusively in elderly patients. Our real-world experience advises against exceeding 1–1.5 mg/kg/day of corticosteroids for severe COVID-19 with an ARDS, especially in older subjects. This reinforces the rationale of modulating rather than suppressing immune responses in these patients.