ABSTRACT
Aims: We assessed the effectiveness of early administration of corticosteroids in patients affected by COVID-19 with moderate to severe acute respiratory distress syndrome requiring oxygen support. Methods: This is a single-center, retrospective, controlled cohort study including patients admitted to our hospital from March 13th to April 20th, 2020. Patients received an intravenous bolus of 8mg dexamethasone twice daily for 5 days or standard care only. Clinical and laboratory characteristics were abstracted by medical records. The primary endpoint was clinical improvement, defined as an increase in the arterial partial pressure of oxygen/fraction of inspired oxygen ratio ≥50%, respiratory rate <24 breaths/min, and decrease in C-reactive protein (CRP) ≥50% compared to the baseline. The secondary endpoint was weaning from any ventilatory support. Outcomes were assessed using Kaplan-Meier analysis with Log-rank test and multivariable Cox regression. Results: Thirty-seven patients (21.6% female;mean age, 63.3±11.4 years) were identified who needed non-invasive mechanical ventilation, 23 of whom received steroids and 14 standard care. Median follow-up was 20 days (range 7-52). Treatment with dexamethasone was associated with faster clinical improvement than standard care [median days, 2 vs. 6;hazard ratio (HR), 3.28;95% confidence interval (CI), 1.64-6.55;P <.0001) and earlier weaning from ventilatory support (median days, 4 vs. 7;HR, 2.24;95% CI, 1.13-4.43;P =.014). CRP decreased over time only in patients on corticosteroids (treatment effect P <.001). Conclusion: In COVID-19 patients with moderate-to-severe ARDS the early use of dexamethasone prevented disease progression, resulting from host inflammatory response, and improved clinical outcome.