Viral clearance after early corticosteroid treatment in patients with moderate or severe covid-19

Abstract

The aim of this study was to evaluate the impact of early treatment with corticosteroids on SARS-CoV-2 clearance in hospitalized COVID-19 patients. Retrospective analysis on patients admitted to the San Raffaele Hospital (Milan, Italy) with moderate/severe COVID-19 and availability of at least two nasopharyngeal swabs. The primary outcome was the time to nasopharyngeal swab negativization. A multivariable Cox model was fitted to determine factors associated with nasopharyngeal swab negativization. Of 280 patients included, 59 (21.1%) patients were treated with steroids. Differences observed between steroid users and non-users included the proportion of patients with a baseline PaO₂/FiO₂ ≤ 200 mmHg (45.8% vs 34.4% in steroids and non-steroids users, respectively; p = 0.023) or ≤ 100 mmHg (16.9% vs 12.7%; p = 0.027), and length of hospitalization (20 vs 14 days; p < 0.001). Time to negativization of nasopharyngeal swabs was similar in steroid and non-steroid users (p = 0.985). According to multivariate analysis, SARS-CoV-2 clearance was associated with age ≤ 70 years, a shorter duration of symptoms at admission, a baseline PaO₂/FiO₂ > 200 mmHg, and a lymphocyte count at admission > 1.0 × 10⁹/L. SARS-CoV-2 clearance was not associated with corticosteroid use. Our study shows that delayed SARS-CoV-2 clearance in moderate/severe COVID-19 is associated with older age and a more severe disease, but not with an early use of corticosteroids.

Figure 1

Distribution of follow-up nasopharyngeal swabs according to days since first positive swab and use of steroid (A); time to negativization of nasopharyngeal swab according to the use of steroid (B).

Figure 2

Time to negativization of nasopharyngeal swab according to: age (A); body mass index (B); days from symptoms to hospital admission (C); PaO₂/FiO₂ at hospital admission (D); total lymphocytes count at hospital admission (E); use of immunomodulatory drugs (F).