Faculty Collaboration Database

Do high-dose corticosteroids improve outcomes in hospitalized COVID-19 patients? J Med Virol 2022 Jan;94(1):372-379

Date

09/25/2021

Pubmed ID

34559436

Pubmed Central ID

PMC8661573

DOI

10.1002/jmv.27357

Scopus ID

2-s2.0-85116399264 (requires institutional sign-in at Scopus site)   15 Citations

Abstract

Coronavirus disease 2019 (COVID-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 has been debated. This was a retrospective observation of COVID-19 admissions between March 1, 2020, and March 10, 2021. Adult patients (≥18 years) who received more than 10 mg daily methylprednisolone equivalent dosing (MED) within the first 14 days were included. We excluded patients who were discharged or died within 7 days of admission. We compared the standard dose of steroids (<40 mg MED) versus the high dose of steroids (>40 mg MED). Inverse probability weighted regression adjustment (IPWRA) 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. Of the 1379 patients meeting study criteria, 506 received less than 40 mg of MED (median dose 30 mg MED) and 873 received more than or equal to 40 mg of MED (median dose 78 mg MED). Unadjusted in-hospital mortality was higher in patients who received high-dose corticosteroids (40.7% vs. 18.6%, p < 0.001). On IPWRA, the use of high-dose corticosteroids was associated with higher odds of death (odds ratio [OR] 2.14; 95% confidence interval [CI] 1.45-3.14, p < 0.001) but not with the development of HAI, readmissions, or requirement of IMV. High-dose corticosteroids were associated with lower rates of AKI requiring hemodialysis (OR 0.33; 95% CI 0.18-0.63). In COVID-19, corticosteroids more than or equal to 40 mg MED were associated with higher in-hospital mortality.

Author List

Kumar G, Patel D, Hererra M, Jefferies D, Sakhuja A, Meersman M, Dalton D, Nanchal R, Guddati AK

Author

Rahul Sudhir Nanchal MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Kidney Injury
Adrenal Cortex Hormones
Aged
Aged, 80 and over
Cross Infection
Female
Hospital Mortality
Humans
Male
Methylprednisolone
Middle Aged
Respiration, Artificial
Retrospective Studies