Late Breaking Abstract - Corticosteroids reduce mortality and prevent ICU admission in Covid-19 pneumonia -results from a rapid clinical review of 191 patients

ABSTRACT

Can early use of corticosteroids prevent progression of Covid-19 pneumonia to full-blown ARDS, and reduce mortality? Clinical data for use of corticosteroids in severe coronavirus infections are mixed - there is a particular lack of evidence in patients in the pre-critical care stage of illness i.e. before decompensation into severe respiratory failure or other organ dysfunction necessitating a critical care admission. Early experience during the initial surge of admissions at our large teaching hospital suggested improved clinical outcomes in some patients treated with corticosteroids. We therefore carried out a rapid retrospective review of all Covid-19 related admissions (n=422) to the hospital from 12th March 2020 (when the first patient was admitted) until 28th April 2020. There was no significant difference in length of stay or total number of days on oxygen -however there was a marked, statistically significant difference in in-hospital mortality (28% in the corticosteroid group versus 65% in the standard treatment group, p=0.00013), as well as a reduction in the need for critical care admission (7.7% versus 49%). Until robust data from RCTs emerges, we suggest that treating a selected group of patients with Covid-19 pneumonia with corticosteroids at the right time is crucial. Timely treatment may attenuate the excessive host respiratory and systemic inflammatory responses, preventing progression to ARDS and death.