Potential benefits of precise corticosteroid therapy for critical COVID-19

Respir Physiol Neurobiol. 2022 Mar;297:103813. doi: 10.1016/j.resp.2021.103813. Epub 2021 Nov 18.


This study was aimed to explore the precise dose of corticosteroid therapy in critical COVID-19. A total of forty-five critical COVID-19 patients were enrolled. The process of critical COVID-19 was divided into alveolitis and fibrosis stages. Most nonsurvivors died in fibrosis phase. Nonsurvivors had more dyspnea symptoms, fewer days of hospitalization, shorter duration of alveolitis and fibrosis. High-dose daily corticosteroid therapy (≥150 mg/d) was associated with shorter survival time and lower lymphocyte count in fibrosis phase. Moreover, a high cumulative dose (≥604 mg) was tied to longer duration of virus shedding, lower oxygenation index (OI), higher incidence of tracheal intubation, fewer lymphocytes and higher levels of C-reactive protein (CRP) and lactate dehydrogenase (LDH). In alveolitis phase, the low-to-moderate-dose daily corticosteroid therapy and a small cumulative dose reduced lymphocytes. In conclusion, low-to-moderate dose corticosteroids may be beneficial in the fibrosis phase. High-dose corticosteroid therapy in the fibrosis phase aggravates the severity of critical COVID-19.

Keywords: COVID-19; Corticosteroid; Lymphocytes; Overall survival; Pulmonary fibrosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / therapeutic use
  • Aged
  • C-Reactive Protein / metabolism
  • COVID-19 / blood
  • COVID-19 / diagnostic imaging
  • COVID-19 / physiopathology
  • COVID-19 Drug Treatment*
  • Critical Illness
  • Female
  • Fibrosis
  • Glucocorticoids / administration & dosage*
  • Glucocorticoids / therapeutic use
  • Humans
  • L-Lactate Dehydrogenase / metabolism
  • Lung / diagnostic imaging*
  • Lung / pathology
  • Lung / physiopathology
  • Lymphocyte Count
  • Male
  • Methylprednisolone / administration & dosage
  • Methylprednisolone / therapeutic use
  • Middle Aged
  • Prednisolone / administration & dosage
  • Prednisolone / therapeutic use
  • SARS-CoV-2
  • Severity of Illness Index
  • Survival Rate
  • Tomography, X-Ray Computed
  • Virus Shedding


  • Adrenal Cortex Hormones
  • Glucocorticoids
  • C-Reactive Protein
  • Prednisolone
  • L-Lactate Dehydrogenase
  • Methylprednisolone