Effectiveness of glucocorticoids in patients hospitalized for severe SARS-CoV-2 pneumonia

Abstract

Introduction: Several studies have reported the beneficial effect of glucocorticoids in the treatment of cytokine storm that occurs in patients with severe COVID-19. Various glucocorticoids regimens have been proposed.

Methods: Retrospective observational study that includes patients with severe SARS-CoV-2 pneumonia and compares admission to an Intensive Care Unit (ICU) or death during hospitalization in three groups of patients: no glucocorticoids treatment, use of glucocorticoids doses equivalent to less than 250mg of prednisone daily and use of equivalent doses greater than or equal to 250mg of prednisone daily. Multivariate analysis was performed using logistic regression, using the propensity index as a covariant.

Results: Of the 259 patients enrolled in the study, 67 (25.9%) had an unfavorable evolution, dying or requiring ICU admission. Comparative analyzes between different glucocorticoids treatments and the association with ICU admission or death were: glucocorticoids treatment (any dose) versus no glucocorticoids treatment (OR: 0.71 [0.30-1.66]), treatment with glucocorticoids (≥250mg prednisone daily) versus no glucocorticoids treatment (OR: 0.35 [0.11-1.08]) and glucocorticoids treatment (≥250mg prednisone daily) versus patients with glucocorticoids doses <250mg prednisone daily or without glucocorticoids treatment (OR: 0.30 [0.10-0.88]).

Conclusion: The results of this study show that patients with severe SARS-CoV-2 pneumonia treated with glucocorticoids pulses with equivalent doses of prednisone greater than or equal to 250mg have a more favorable evolution (less mortality and less admission to ICU).

Keywords: Coronavirus infection disease 2019 (COVID-19); Corticoides; Corticosteroids; Enfermedad por coronavirus 2019 (COVID-19); Propensity index; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); Síndrome agudo respiratorio severo por coronavirus 2 (SARS-CoV-2); Índice de propensión.

Figura 1

Diagrama de flujo de pacientes incluidos y excluidos en el estudio. HBPM: heparina de bajo peso molecular; PCR: amplificación genómica mediante reacción en cadena de la polimerasa; Rx: radiografía; SAFI: cociente entre saturación de oxígeno y fracción inspiratoria de oxígeno; UCI: unidad de cuidados intensivos.