A Retrospective Controlled Cohort Study of the Impact of Glucocorticoid Treatment in SARS-CoV-2 Infection Mortality

Antimicrob Agents Chemother. 2020 Aug 20;64(9):e01168-20. doi: 10.1128/AAC.01168-20. Print 2020 Aug 20.

Abstract

Evidence to support the use of steroids in coronavirus disease 2019 (COVID-19) pneumonia is lacking. We aim to determine the impact of steroid use for COVID-19 pneumonia on hospital mortality. We performed a single-center retrospective cohort study in a university hospital in Madrid, Spain, during March of 2020. To determine the role of steroids in in-hospital mortality, patients admitted with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia and treated with steroids were compared to patients not treated with steroids, and we adjusted with a propensity score for patients on steroid treatment. Survival times were compared using the log rank test. Different steroid regimens were compared and adjusted with a second propensity score. During the study period, 463 out of 848 hospitalized patients with COVID-19 pneumonia fulfilled inclusion criteria. Among them, 396 (46.7%) patients were treated with steroids and 67 patients were not. Global mortality was 15.1%. The median time to steroid treatment from symptom onset was 10 days (interquartile range [IQR], 8 to 13 days). In-hospital mortality was lower in patients treated with steroids than in controls (13.9% [55/396] versus 23.9% [16/67]; hazard ratio [HR], 0.51 [95% confidence interval, 0.27 to 0.96]; P = 0.044). Steroid treatment reduced mortality by 41.8% relative to the mortality with no steroid treatment (relative risk reduction, 0.42 [95% confidence interval, 0.048 to 0.65]). Initial treatment with 1 mg/kg of body weight/day of methylprednisolone versus steroid pulses was not associated with in-hospital mortality (13.5% [42/310] versus 15.1% [13/86]; odds ratio [OR], 0.880 [95% confidence interval, 0.449 to 1.726]; P = 0.710). Our results show that the survival of patients with SARS-CoV-2 pneumonia is higher in patients treated with glucocorticoids than in those not treated. Rates of in-hospital mortality were not different between initial regimens of 1 mg/kg/day of methylprednisolone and glucocorticoid pulses.

Keywords: COVID-19; mortality; steroids.

MeSH terms

  • Aged
  • Antiviral Agents / therapeutic use*
  • Azithromycin / therapeutic use*
  • Betacoronavirus / drug effects*
  • Betacoronavirus / immunology
  • Betacoronavirus / pathogenicity
  • COVID-19
  • Cardiovascular Diseases / drug therapy
  • Cardiovascular Diseases / immunology
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / virology
  • Comorbidity
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / immunology
  • Coronavirus Infections / mortality
  • Coronavirus Infections / virology
  • Diabetes Mellitus / drug therapy
  • Diabetes Mellitus / immunology
  • Diabetes Mellitus / mortality
  • Diabetes Mellitus / virology
  • Drug Administration Schedule
  • Drug Combinations
  • Drug Therapy, Combination
  • Dyslipidemias / drug therapy
  • Dyslipidemias / immunology
  • Dyslipidemias / mortality
  • Dyslipidemias / virology
  • Female
  • Hospitals, University
  • Humans
  • Hydroxychloroquine / therapeutic use*
  • Intensive Care Units
  • Interferons / therapeutic use*
  • Length of Stay / statistics & numerical data
  • Lopinavir / therapeutic use*
  • Male
  • Methylprednisolone / therapeutic use*
  • Middle Aged
  • Neoplasms / drug therapy
  • Neoplasms / immunology
  • Neoplasms / mortality
  • Neoplasms / virology
  • Pandemics
  • Pneumonia, Viral / drug therapy*
  • Pneumonia, Viral / immunology
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / virology
  • Retrospective Studies
  • Ritonavir / therapeutic use*
  • SARS-CoV-2
  • Survival Analysis

Substances

  • Antiviral Agents
  • Drug Combinations
  • lopinavir-ritonavir drug combination
  • Lopinavir
  • Hydroxychloroquine
  • Azithromycin
  • Interferons
  • Ritonavir
  • Methylprednisolone