Role of the early short-course corticosteroids treatment in ARDS caused by COVID-19: A single-center, retrospective analysis

Lucio Boglione; Carlo Olivieri; Roberto Rostagno; Federica Poletti; Roberta Moglia; Bianca Bianchi; Maria Esposito; Stefano Biffi; Silvio Borrè

doi:10.1016/j.advms.2021.04.002

Role of the early short-course corticosteroids treatment in ARDS caused by COVID-19: A single-center, retrospective analysis

Adv Med Sci. 2021 Sep;66(2):262-268. doi: 10.1016/j.advms.2021.04.002. Epub 2021 Apr 24.

Authors

Lucio Boglione¹, Carlo Olivieri², Roberto Rostagno³, Federica Poletti³, Roberta Moglia³, Bianca Bianchi³, Maria Esposito³, Stefano Biffi³, Silvio Borrè³

Affiliations

¹ Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy. Electronic address: lucio.boglione@uniupo.it.
² Division of Anesthesia and Intensive Care, Saint Andrea Hospital, Vercelli, Italy.
³ Division of Infectious Diseases, Saint Andrea Hospital, Vercelli, Italy.

Abstract

Purpose: Severe coronavirus disease 2019 (COVID-19) is strongly related to interstitial pneumonia with frequent development of acute respiratory distress syndrome (ARDS). The role of corticosteroids (CS) treatment in these patients is still controversial. Some studies evidenced a possible role of an early short-term course of CS treatment in the treatment of severe pneumonia.

Patients and methods: This is a single-center, retrospective study considering the patients with confirmed COVID-19 pneumonia admitted to our hospital between 9th March and 15^th June 2020. Two groups were considered: early high-dose of methyl-prednisolone (eHDM; n = 31) and the control group (n = 52). Patients in the eHDM group received the dose of 5-8 mg/kg/day of methyl-prednisolone for 2 consecutive days. Primary outcome was the mortality evaluation; secondary outcomes were clinical improvement, side-effects and laboratory/radiographic changes.

Results: Significant differences between the two groups were: length of hospitalization (21.5 vs 28.4 days, p = 0.026), length of non-invasive ventilation (NIV) or mechanical ventilation (11.5 vs 14.5 days, p = 0.031), death (5 vs 12, p = 0.006) and clinical improvement (16 vs 11, p=0.018). The following factors were related to in-hospital mortality in the multivariate analysis: comorbidities (OR = 2.919; 95%CI = 1.515-16.705; p<0.001), days from the onset of symptoms and the hospital admission (OR = 1.404; 95%CI = 1.069-12.492; p = 0.011), PaO₂/FiO₂ (P/F) ratio (OR = 3.111; 95%CI = 2.334-16.991; p = 0.009) and eHDM treatment (OR = 0.741; 95%CI = 0.129-0.917; p = 0.007).

Conclusion: The eHDM is an interesting and promising approach in the ARDS related to COVID-19 pneumonia, which reduces mortality, length of hospitalization and the need for mechanical ventilation.

Keywords: ARDS; COVID-19; Corticosteroids; Early treatment; SARS-CoV-2.

MeSH terms

Adrenal Cortex Hormones / administration & dosage
Aged
COVID-19* / diagnosis
COVID-19* / physiopathology
COVID-19* / therapy
Dose-Response Relationship, Drug
Duration of Therapy
Early Medical Intervention / methods
Female
Hospital Mortality
Humans
Italy / epidemiology
Lung / diagnostic imaging*
Male
Methylprednisolone / administration & dosage*
Outcome and Process Assessment, Health Care
Pneumonia, Viral* / diagnosis
Pneumonia, Viral* / drug therapy
Pneumonia, Viral* / virology
Respiration, Artificial / statistics & numerical data
Respiratory Distress Syndrome* / diagnosis
Respiratory Distress Syndrome* / etiology
Respiratory Distress Syndrome* / therapy
SARS-CoV-2 / isolation & purification*
Severity of Illness Index
Treatment Outcome

Substances

Adrenal Cortex Hormones
Methylprednisolone