Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Jan;27(1):105-111.
doi: 10.1016/j.cmi.2020.09.014. Epub 2020 Sep 22.

Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study

Michele Bartoletti  1 , Lorenzo Marconi  2 , Luigia Scudeller  3 , Livia Pancaldi  4 , Sara Tedeschi  4 , Maddalena Giannella  4 , Matteo Rinaldi  4 , Linda Bussini  4 , Ilaria Valentini  5 , Anna Filomena Ferravante  5 , Antonella Potalivo  6 , Elisa Marchionni  2 , Giacomo Fornaro  4 , Renato Pascale  4 , Zeno Pasquini  7 , Massimo Puoti  8 , Marco Merli  8 , Francesco Barchiesi  7 , Francesca Volpato  4 , Arianna Rubin  4 , Annalisa Saracino  9 , Tommaso Tonetti  10 , Paolo Gaibani  11 , Vito Marco Ranieri  10 , Pierluigi Viale  4 , Francesco Cristini  2 ; PREDICO Study Group
Affiliations
Observational Study

Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study

Michele Bartoletti et al. Clin Microbiol Infect. 2021 Jan.

Abstract

Objective: To assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19).

Methods: A multicentre observational study was performed from 22 February through 30 June 2020. We included consecutive adult patients with severe COVID-19, defined as respiratory rate ≥30 breath per minute, oxygen saturation ≤93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ≤300 mm Hg. We excluded patients being treated with other immunomodulant drugs, receiving low-dose corticosteroids and receiving corticosteroids 72 hours after admission. The primary endpoint was 30-day mortality from hospital admission. The main exposure variable was corticosteroid therapy at a dose of ≥0.5 mg/kg of prednisone equivalents. It was introduced as binomial covariate in a logistic regression model for the primary endpoint and inverse probability of treatment weighting using the propensity score.

Results: Of 1717 patients with COVID-19 evaluated, 513 were included in the study, and of these, 170 (33%) were treated with corticosteroids. During hospitalization, 166 patients (34%) met the criteria of the primary outcome (60/170, 35% in the corticosteroid group and 106/343, 31% in the noncorticosteroid group). At multivariable analysis corticosteroid treatment was not associated with lower 30-day mortality rate (adjusted odds ratio, 0.59; 95% confidence interval (CI), 0.20-1.74; p 0.33). After inverse probability of treatment weighting, corticosteroids were not associated with lower 30-day mortality (average treatment effect, 0.05; 95% CI, -0.02 to 0.09; p 0.12). However, subgroup analysis revealed that in patients with PO2/FiO2 < 200 mm Hg at admission (135 patients, 52 (38%) treated with corticosteroids), corticosteroid treatment was associated with a lower risk of 30-day mortality (23/52, 44% vs. 45/83, 54%; adjusted odds ratio, 0.20; 95% CI, 0.04-0.90; p 0.036).

Conclusions: The effect of corticosteroid treatment on mortality might be limited to critically ill COVID-19 patients.

Keywords: ARDS; COVID-19; Corticosteroids; Mortality; SARS-CoV-2.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Study flowchart.
See this image and copyright information in PMC

References

    1. Wu Z., McGoogan J.M. JAMA; 2020. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. - PubMed
    1. Richardson S., Hirsch J.S., Narasimhan M., Crawford J.M., McGinn T., Davidson K.W. JAMA; 2020. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. - PMC - PubMed
    1. Grasselli G., Pesenti A., Cecconi M. JAMA; 2020. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. - PubMed
    1. Huang C., Wang Y., Li X., Ren L., Zhao J., Hu Y. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. - PMC - PubMed
    1. Bartoletti M., Giannella M., Scudeller L., Tedeschi S., Rinaldi M., Bussini L. Development and validation of a prediction model for severe respiratory failure in hospitalized patients with SARS-CoV-2 infection: a multicenter cohort study (PREDICO study) Clin Microbiol Infect. 2020 doi: 10.1016/j.cmi.2020.08.003. S1198-743X(20)30479-1. Online ahead of print. - DOI - PMC - PubMed

Publication types

MeSH terms