Benefits of Steroid Therapy in COVID-19 Patients with Different PaO(2)/FiO(2) Ratio at Admission

Vita, Serena; Centanni, Daniele; Lanini, Simone; Piselli, Pierluca; Rosati, Silvia; Giancola, Maria Letizia; Mondi, Annalisa; Pinnetti, Carmela; Topino, Simone; Chinello, Pierangelo; Mosti, Silvia; Gualano, Gina; Faraglia, Francesca; Iacomi, Fabio; Marchioni, Luisa; Maritti, Micaela; Girardi, Enrico; Ippolito, Giuseppe; Nicastri, Emanuele

Introduction: The use of steroid therapy in patients within the context of SARS-CoV-2 infection is still a matter of debate. This study aimed to evaluate if potential steroid benefits could be predicted by the ratio of arterial oxygen partial pressure (PaO(2) in mmHg) to fractional inspired oxygen (FiO(2)) (P/F) in COVID-19 patients at admission. Materials and Methods: Medical records were retrospectively collected from all adult patients admitted because of COVID-19 from 29 January to 31 July 2020. The association of steroid therapy with 28-day all-cause mortality outcome was analysed in a multivariable logistic regression model adjusted for confounding factors. Results: Overall, 511 patients were analysed, of which 39.1% underwent steroid therapy. Steroid treated patients were mostly male, older, and more frequently treated with antiviral drugs and aminoquinolines; the most common comorbidities were hypertension, followed by cardiovascular disease. Overall, 51 patients died within 28-days, and overall 28-days mortality was 19.5% in the cohort of patients exposed to steroids versus 3.9% mortality in unexposed patients (p < 0.001). Steroid therapy on patients with P/F ratio of 235 mmHg or higher at admission can be considered as detrimental, with an 8% increased probability of death. Conclusions: Steroid therapy is associated with increased 28-day mortality in COVID-19 in patients with mild or no ARDS.