Corticosteroid therapy for patients with COVID-19 pneumonia: a before-after study

Abstract

Anti-inflammatory drugs such as corticosteroids may beneficially modulate the host inflammatory response to coronavirus disease 2019 (COVID-19) pneumonia. The aim of this study was to evaluate the impact of addition of corticosteroids to the hospital protocol for treatment of suspected or confirmed COVID-19 pneumonia on rates of death or intensive care unit (ICU) admission. A before-after study was performed to evaluate the effect of addition of corticosteroids to our institution's COVID-19 treatment protocol on hospital mortality. A total of 257 patients with a COVID-19 diagnosis were included in this study between 3 March 2020 and 14 April 2020. As corticosteroids were widely used after 27 March 2020, two periods were considered for the purposes of this study: the 'before' period from 3-20 March 2020 (n = 85); and the 'after' period from 26 March-14 April 2020 (n = 172). The 'after' period was associated with a lower risk of death [adjusted hazard ratio (aHR) = 0.47, 95% confidence interval (CI) 0.23-0.97; P = 0.04] and a lower risk of ICU admission or of death before ICU admission (aHR = 0.37, 95% CI 0.21-0.64; P = 0.0005) by multivariate analysis adjusted for age, National Early Warning score and institutionalisation status. In conclusion, addition of corticosteroids to our institution's COVID-19 treatment protocol was associated with a significant reduction in hospital mortality in the 'after' period.

Keywords: COVID-19; COVID-19 pneumonia; Corticosteroid; SARS-CoV-2.

Fig. 1

Kaplan–Meier curves for (a) death during hospitalisation and (b) ICU admission and/or death before ICU admission between patients ‘before’ and ‘after’ implementation of corticosteroids for COVID-19 pneumonia in Reims University Hospital (Reims, France). The ‘before’ period was 3–20 March 2020 and the ‘after’ period was 26 March–14 April 2020. P = 0.006, log-rank test.