COVID-19 and non-COVID ARDS patients demonstrate a distinct response to low dose steroids- A retrospective observational study

Abstract

Patients with COVID-19 ARDS have distinct physiological and immunological phenotypes compared to patients with non-COVID ARDS. Patients with COVID-19 ARDS (n = 32) had a significant improvement in PaO₂: FiO₂ ratio (p = 0.046) following low-dose steroid treatment, unlike patients with non-COVID ARDS (n = 16) (p = 0.529). Patients with COVID-19 ARDS had a greater fall in CRP compared to patients with non-COVID ARDS, albeit not statistically significant (p = 0.07). Our novel findings highlight differences in the underlying physiological and immunological phenotypes between COVID-19 and non-COVID ARDS, with implications for future ARDS studies.

Keywords: ARDS; COVID-19; Inflammation; Steroids.

Fig. 1

Change in CRP, PaO₂: FiO₂ ratio, neutrophil count, and temperature between patient (a-d) with and (e- h) without COVID-19 between initiation of low dose steroid and 3 days after steroid treatment (either hydrocortisone (50-100 mg 6- hourly) or methylprednisolone (1-2 mg/kg daily). Patients with (a) COVID-19 and (e) Non-COVID-19 ARDS demonstrate significant reduction in CRP over 3 days from steroid initiation. Only patients with (b) COVID-19 ARDS demonstrate an increase in PaO₂: FiO₂ ratio following steroid treatment, but not patients with (f) Non-COVID-19 ARDS. Core temperature however, only falls in patients with (h) Non-COVID-19 ARDS but not in those with (d) COVID-19 ARDS following steroid treatment. Data represent median and interquartile range. Data are assessed using Wilcoxon sign rank test.