Opportunity for severe and critical COVID-19 pneumonia treatment with corticosteroids: a retrospective cohort study

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has been the most significant infectious disease outbreak worldwide in the past 3 years, with the potential to progress to severe pneumonia and trigger systemic inflammatory response, posing a threat to human health and life. This study aims to explore the use of corticosteroids for COVID-19 and provide recommendations on the timing and dosage of the treatment.

Methods: We conducted a retrospective cohort study, enrolling 100 with COVID-19 pneumonia between December 2022 and January 2023. The diagnosis of severe and critical COVID-19 pneumonia patients was according to China's Ninth Edition of the Diagnosis and Treatment Plan for COVID-19 Pneumonia. T test and univariate proportional hazard analysis were employed to investigate the opportunity of corticosteroids therapy in relation to patients' prognosis.

Results: Compared to COVID-19 pneumonia patients treated with corticosteroids in the early phase, those who received late-phase corticosteroid therapy had a higher proportion of intensive care unit (ICU) admission (P=0.01), longer hospital stay (P=0.006), lower in-hospital survival rate (P=0.03), and slower recovery (P<0.001). A significant difference was also observed in logistic univariate proportional hazard analysis.

Conclusions: The early administration of corticosteroid therapy has been shown to significantly improve the prognosis of COVID-19 pneumonia patients, promoting recovery with significant clinical significance. Our recommendation for the administration of corticosteroid therapy is to be applied on the 6th-9th day of persisting unrelieved symptoms of COVID-19 pneumonia.

Keywords: Coronavirus disease 2019 pneumonia (COVID-19 pneumonia); corticosteroids; hospital length of stay; prognosis; survival.

Figure 1

The survival curves of the two groups.