Real-world effectiveness of steroids in severe COVID-19: a retrospective cohort study

BMC Infect Dis. 2022 Oct 5;22(1):776. doi: 10.1186/s12879-022-07750-3.


Introduction: Randomised controlled trials have shown that steroids reduce the risk of dying in patients with severe Coronavirus disease 2019 (COVID-19), whilst many real-world studies have failed to replicate this result. We aim to investigate real-world effectiveness of steroids in severe COVID-19.

Methods: Clinical, demographic, and viral genome data extracted from electronic patient record (EPR) was analysed from all SARS-CoV-2 RNA positive patients admitted with severe COVID-19, defined by hypoxia at presentation, between March 13th 2020 and May 27th 2021. Steroid treatment was measured by the number of prescription-days with dexamethasone, hydrocortisone, prednisolone or methylprednisolone. The association between steroid > 3 days treatment and disease outcome was explored using multivariable cox proportional hazards models with adjustment for confounders (including age, gender, ethnicity, co-morbidities and SARS-CoV-2 variant). The outcome was in-hospital mortality.

Results: 1100 severe COVID-19 cases were identified having crude hospital mortality of 15.3%. 793/1100 (72.1%) individuals were treated with steroids and 513/1100 (46.6%) received steroid ≤ 3 days. From the multivariate model, steroid > 3 days was associated with decreased hazard of in-hospital mortality (HR: 0.47 (95% CI: 0.31-0.72)).

Conclusion: The protective effect of steroid treatment for severe COVID-19 reported in randomised clinical trials was replicated in this retrospective study of a large real-world cohort.

Keywords: COVID-19; Mortality; Retrospective cohort study; Steroids.

MeSH terms

  • COVID-19 Drug Treatment*
  • Dexamethasone
  • Humans
  • Hydrocortisone
  • Methylprednisolone / therapeutic use
  • RNA, Viral
  • Retrospective Studies
  • SARS-CoV-2*


  • RNA, Viral
  • Dexamethasone
  • Hydrocortisone
  • Methylprednisolone

Supplementary concepts

  • SARS-CoV-2 variants