Viral clearance after early corticosteroid treatment in patients with moderate or severe covid-19

Sci Rep. 2020 Dec 4;10(1):21291. doi: 10.1038/s41598-020-78039-1.

Abstract

The aim of this study was to evaluate the impact of early treatment with corticosteroids on SARS-CoV-2 clearance in hospitalized COVID-19 patients. Retrospective analysis on patients admitted to the San Raffaele Hospital (Milan, Italy) with moderate/severe COVID-19 and availability of at least two nasopharyngeal swabs. The primary outcome was the time to nasopharyngeal swab negativization. A multivariable Cox model was fitted to determine factors associated with nasopharyngeal swab negativization. Of 280 patients included, 59 (21.1%) patients were treated with steroids. Differences observed between steroid users and non-users included the proportion of patients with a baseline PaO2/FiO2 ≤ 200 mmHg (45.8% vs 34.4% in steroids and non-steroids users, respectively; p = 0.023) or ≤ 100 mmHg (16.9% vs 12.7%; p = 0.027), and length of hospitalization (20 vs 14 days; p < 0.001). Time to negativization of nasopharyngeal swabs was similar in steroid and non-steroid users (p = 0.985). According to multivariate analysis, SARS-CoV-2 clearance was associated with age ≤ 70 years, a shorter duration of symptoms at admission, a baseline PaO2/FiO2 > 200 mmHg, and a lymphocyte count at admission > 1.0 × 109/L. SARS-CoV-2 clearance was not associated with corticosteroid use. Our study shows that delayed SARS-CoV-2 clearance in moderate/severe COVID-19 is associated with older age and a more severe disease, but not with an early use of corticosteroids.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Age Factors
  • Aged
  • COVID-19 / drug therapy*
  • COVID-19 / epidemiology
  • Female
  • Hospitalization
  • Humans
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Pandemics
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Viral Load / drug effects*

Substances

  • Adrenal Cortex Hormones