Effect of Systemic Glucocorticoids on Mortality or Mechanical Ventilation in Patients With COVID-19

J Hosp Med. 2020 Aug;15(8):489-493. doi: 10.12788/jhm.3497.

Abstract

The efficacy of glucocorticoids in COVID-19 is unclear. This study was designed to determine whether systemic glucocorticoid treatment in COVID-19 patients is associated with reduced mortality or mechanical ventilation. This observational study included 1,806 hospitalized COVID-19 patients; 140 were treated with glucocorticoids within 48 hours of admission. Early use of glucocorticoids was not associated with mortality or mechanical ventilation. However, glucocorticoid treatment of patients with initial C-reactive protein (CRP) ≥20 mg/dL was associated with significantly reduced risk of mortality or mechanical ventilation (odds ratio, 0.23; 95% CI, 0.08-0.70), while glucocorticoid treatment of patients with CRP <10 mg/dL was associated with significantly increased risk of mortality or mechanical ventilation (OR, 2.64; 95% CI, 1.39-5.03). Whether glucocorticoid treatment is associated with changes in mortality or mechanical ventilation in patients with high or low CRP needs study in prospective, randomized clinical trials.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Betacoronavirus
  • Body Mass Index
  • C-Reactive Protein / analysis
  • Child
  • Child, Preschool
  • Comorbidity
  • Continental Population Groups
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / mortality*
  • Coronavirus Infections / therapy*
  • Female
  • Glucocorticoids / administration & dosage
  • Glucocorticoids / adverse effects
  • Glucocorticoids / therapeutic use*
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / mortality*
  • Pneumonia, Viral / therapy*
  • Prospective Studies
  • Respiration, Artificial / statistics & numerical data*
  • Time Factors
  • Young Adult

Substances

  • Glucocorticoids
  • C-Reactive Protein

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2