Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study.
OBJECTIVE
To assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19).


METHODS
A multicentre observational study was performed from 22 February through 30 June 2020. We included consecutive adult patients with severe COVID-19, defined as respiratory rate ≥30 breath per minute, oxygen saturation ≤93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ≤300 mm Hg. We excluded patients being treated with other immunomodulant drugs, receiving low-dose corticosteroids and receiving corticosteroids 72 hours after admission. The primary endpoint was 30-day mortality from hospital admission. The main exposure variable was corticosteroid therapy at a dose of ≥0.5 mg/kg of prednisone equivalents. It was introduced as binomial covariate in a logistic regression model for the primary endpoint and inverse probability of treatment weighting using the propensity score.


RESULTS
Of 1717 patients with COVID-19 evaluated, 513 were included in the study, and of these, 170 (33%) were treated with corticosteroids. During hospitalization, 166 patients (34%) met the criteria of the primary outcome (60/170, 35% in the corticosteroid group and 106/343, 31% in the noncorticosteroid group). At multivariable analysis corticosteroid treatment was not associated with lower 30-day mortality rate (adjusted odds ratio, 0.59; 95% confidence interval (CI), 0.20-1.74; p 0.33). After inverse probability of treatment weighting, corticosteroids were not associated with lower 30-day mortality (average treatment effect, 0.05; 95% CI, -0.02 to 0.09; p 0.12). However, subgroup analysis revealed that in patients with PO2/FiO2 < 200 mm Hg at admission (135 patients, 52 (38%) treated with corticosteroids), corticosteroid treatment was associated with a lower risk of 30-day mortality (23/52, 44% vs. 45/83, 54%; adjusted odds ratio, 0.20; 95% CI, 0.04-0.90; p 0.036).


CONCLUSIONS
The effect of corticosteroid treatment on mortality might be limited to critically ill COVID-19 patients.
['Bartoletti|Michele|M|', 'Marconi|Lorenzo|L|', 'Scudeller|Luigia|L|', 'Pancaldi|Livia|L|', 'Tedeschi|Sara|S|', 'Giannella|Maddalena|M|', 'Rinaldi|Matteo|M|', 'Bussini|Linda|L|', 'Valentini|Ilaria|I|', 'Ferravante|Anna Filomena|AF|', 'Potalivo|Antonella|A|', 'Marchionni|Elisa|E|', 'Fornaro|Giacomo|G|', 'Pascale|Renato|R|', 'Pasquini|Zeno|Z|', 'Puoti|Massimo|M|', 'Merli|Marco|M|', 'Barchiesi|Francesco|F|', 'Volpato|Francesca|F|', 'Rubin|Arianna|A|', 'Saracino|Annalisa|A|', 'Tonetti|Tommaso|T|', 'Gaibani|Paolo|P|', 'Ranieri|Vito Marco|VM|', 'Viale|Pierluigi|P|', 'Cristini|Francesco|F|', '|||']
D000305:Adrenal Cortex Hormones D000328:Adult D000368:Aged D000998:Antiviral Agents D000086382:COVID-19 D016638:Critical Illness D005260:Female D006495:Heparin, Low-Molecular-Weight D017052:Hospital Mortality D006761:Hospitals D006801:Humans D006886:Hydroxychloroquine D007558:Italy D007902:Length of Stay D008297:Male D008875:Middle Aged D016017:Odds Ratio D012128:Respiratory Distress Syndrome D012189:Retrospective Studies D000086402:SARS-CoV-2 D012720:Severity of Illness Index D016019:Survival Analysis D016896:Treatment Outcome
Corticosteroids COVID-19 Mortality ARDS SARS-CoV-2