Corticosteroid pulses for hospitalized patients with COVID-19. Effects on mortality and in-hospital stay.

ABSTRACT

Background: COVID-19 has high mortality in hospitalized patients, and we need effective treatments. Our objective was to assess corticosteroid pulses influence on 60-days mortality in hospitalized patients with severe COVID-19, intensive care admission, and hospital stay. Methods: We designed a multicenter retrospective cohort study in three teaching hospitals of Castilla y Leon, Spain (865.096 people). We selected patients with confirmed COVID-19 and lung involvement with a pO2/FiO2 < 300, excluding those exposed to immunosuppressors before or during hospitalization, patients terminally ill at admission, or died the first 24 hours. We performed a propensity score matching (PSM) adjusting covariates that modify the probability of being treated. Then we used a Cox regression model in the PSM group to consider factors affecting mortality. Findings: From 2933 patients, 257 fulfilled the inclusion and exclusion criteria. One hundred and twenty-four patients were on corticosteroid pulses, and 133 were not. 30{middle dot}3% (37/122) of patients died in the corticosteroid pulses group and 42{middle dot}9% (57/133) in the non-exposed cohort. These differences (12{middle dot}6% CI95% [8{middle dot}54-16{middle dot}65]) were statically significant (log-rank 4{middle dot}72, p=0{middle dot}03). We performed PSM using the exact method. Mortality differences remained in the PSM group (log-rank 5{middle dot}31, p=0{middle dot}021) and were still significant after a Cox regression model (HR for corticosteroid pulses 0{middle dot}561, p= 0{middle dot}039). There were no significant differences in intensive care admission rate (p=0{middle dot}173). The hospital stay was longer in the corticosteroid group (p<0,001). Interpretation: This study provides evidence about treatment with corticosteroid pulses in severe COVID-19 that might significantly reduce mortality. Strict inclusion and exclusion criteria with that selection process set a reliable frame to compare mortality in both exposed and non-exposed groups. Funding: There was no funding provided.