Evaluation of Corticosteroid Duration on Sars-Cov-2 Acute Respiratory Distress Syndrome

ABSTRACT

INTRODUCTION: Corticosteroids are standard of care for hospitalized COVID-19 patients requiring oxygen supplementation. However, studies evaluating the clinical impact of corticosteroid use beyond 10 days for treatment of COVID-19 are limited. We sought to analyze the impact of extending corticosteroid duration beyond 10 days on 28-day mortality, median hospital length of stay (LOS), intensive care unit (ICU) LOS, mechanical ventilation (MV) duration, and secondary infection risk in patients with COVID-19. METHOD(S) This single-center retrospective study examined 139 hospitalized adult ICU patients receiving corticosteroids for COVID-19 from August 2020 to January 2021. Patients were divided into two groups standard therapy (<=10 days of corticosteroids;n=45) and extended therapy (>10 days of corticosteroids;n=94). The effect of corticosteroid duration on outcomes was analyzed, with adjustments for confounders made by multivariate regression analysis. RESULT(S) 28-day mortality was not impacted by steroid duration (37/94 [39%] in extended therapy arm vs 22/45 [48%] in standard therapy arm;p=0.29). Rate of secondary infection was higher (40% vs 18%;p< 0.01) and median ICU LOS was longer (14 (9-20) days vs 9 (3-17) days;p=0.01) in the extended therapy group compared to the standard therapy group. However, median hospital LOS and MV duration did not differ between the groups (p=0.07 and p=0.34, respectively). After multivariate analysis, risk of secondary infection remained elevated in the extended therapy arm versus the standard therapy arm (40% vs 18%;adjusted p= 0.04);however, after multivariate analysis, steroid duration did not impact 28-day mortality (p=0.60), ICU LOS (p=0.10), or hospital LOS (p=0.06). CONCLUSION(S) Extending corticosteroid therapy beyond 10 days did not impact mortality at 28 days among a cohort of critically ill patients with COVID-19 but was associated with higher rates of secondary infection.