Outcomes of Steroid and Pulse Steroid Therapies in COVID-19 Inpatients Requiring Oxygen Therapy, Retrospective Case Control Study
Abstract
Background: A limited number of studies have been conducted examining the course of the disease and the effectiveness of corticosteroid treatments in patients with severe COVID-19 pneumonia requiring oxygen support. This study assessed steroid effectiveness in oxygen-dependent COVID-19 patients.
Methods: Included in the study were 670 patients who required oxygen support during their hospital stay among the 6,532 Covid-19 patients between 1 August 2020 and 1 June 2021. Demographic data, comorbidities, duration of oxygen therapy, length of hospital stay, corticosteroid treatments (dexamethasone, methylprednisolone) and pulse corticosteroid treatments (methylprednisolone ≥ 250 mg) were recorded. We analyzed data using Statistical Package for the Social Sciences Program (Version 16.0. Chicago, SPSS) and applied Shapiro-Wilk, Mann-Whitney U, Kruskal-Wallis, and Chi-square tests for statistical significance (p<0.05).
Results: The mean age of the patients was 64±13 (19–95) years, 55% were male, and the mean duration of hospital stay was 9±6 (1–64) days. Dexamethasone, pulse steroids, and low-dose methylprednisolone (<80 mg) were given to 41%, 13%, and 18% of patients, respectively. 31.6% required ICU admission, and the overall hospital mortality rate was 18.1%. Notably, 83% of deaths occurred within the first week.
Conclusion: Most deaths in oxygen-dependent COVID-19 patients happened within 7 days. While corticosteroids didn’t impact overall mortality, dexamethasone seemed to boost discharge without ICU admission.
Keywords
COVID-19, dexamethasone, mortality, oxygen therapy, pulse corticosteroid therapy
Ethical Statement
The study was approved by both the Turkish Ministry of Health and the Ethics Committee of Trakya University Faculty of Medicine (Decision Date: 27/12/2021 and No: 25/49), and all necessary administrative permissions were obtained from the Turkish Ministry of Health, the Eskişehir Provincial Health Directorate and the Office of the Chief Physician of Eskişehir City Hospital. This study carried out following the principles of the Declaration of Helsinki and all applicable regulations.
References
- Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021; 384(8):693-704. doi: 10.1056/NEJMoa2021436.
- Edalatifard M, Akhtari M, Salehi M, Naderi Z, Jamshidi A, Mostafaei S, et al. Intravenous methylprednisolone pulse as a treatment for hospitalised severe COVID-19 patients: Results from a randomised controlled clinical trial. Eur Respir J 2020;56:2002808. doi: 10.1183/13993003.02808-2020
- Ayyildiz A, Yıldırım ÖT, Uçan A, Ayyildiz FA. Evaluation of Steroid Therapy in COVID-19 Patients; in the Right Dose at the Right Time to the Right Patients. Nigerian Journal of Clinical Practice 2023;26(3):280-6, March 2023.
- Dequin PF, Heming N, Meziani F, Plantefève G, Voiriot G, Badié J, et al. Effect of hydrocortisone on 21 day mortality or respiratory support among critically ıll patients with COVID 19: A randomized clinical trial. JAMA 2020;324:1298-306.
- Angus DC, Derde L, Al-Beidh F, Annane D, Arabi Y, Beane A, et al. Effect of hydrocortisone on mortality and organ support in patients with severe COVID-19: The REMAP-CAP COVID-19 corticosteroid domain randomized clinical trial. JAMA 2020;324:1317-29.
- RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 2021;384:693-704
- Mohanty RR, Biswa Mohan Padhy, Meher BR. Effectiveness of pulse dose methyl prednisolone in management of COVID 19: A systematic review and meta-analysis of observational studies. J Pharm Pharm Sci 2022;25:110-23.
- Monedero P, Gea A, Castro P, Candela-Toho AM, Hernández-Sanz ML, Arruti E, et al. Early corticosteroids are associated with lower mortality in critically ill patients with COVID-19: a cohort study. Critical Care. 2021;25(1):1-7. https://doi.org/10.1186/s13054-020-03422-3.
- Ho KS, Narasimhan B, Difabrizio L, Rogers L, Bose S, Li L, et al. Impact of corticosteroids in hospitalised COVID-19 patients. BMJ Open Respiratory Research. 2021;8(1):1-7. https://doi.org/10.1136/bmjresp-2020-000766.
- Cheng B, Ma J, Yang Y, Shao T, Zhao B, Zeng L. Systemic corticosteroid administration in coronavirus disease 2019 outcomes: an umbrella meta-analysis incorporating both mild and pulmonary fibrosis–manifested severe disease. Frontiers in Pharmacology. 2021;12(1):1-7. https://doi.org/10.3389/fphar.2021.670170.