COMPARISON OF PULSE-DOSE AND HIGH-DOSE CORTICOSTEROIDS WITH NO CORTICOSTEROID TREATMENT FOR COVID-19 PNEUMONIA IN THE INTENSIVE CARE UNIT.

Yaqoob, Hamid; Greenberg, Daniel; Hwang, Frank; Lee, Curtis; Vernik, David; Manglani, Ravi; Wang, Zhen; Murad, M Hassan; Chandy, Dipak; Epelbaum, Oleg

INTRODUCTION Corticosteroid dosing in the range of 0.5-2mg/kg/day of methylprednisolone equivalents have become a standard part of the management of ICU patients with COVID-19 pneumonia based on positive results of randomized trials and a meta-analysis. Alongside such conventional dosing, administration of 1gm of methylprednisolone daily (pulse dosing) has also been reported in the literature with claims of favorable outcomes. Comparisons between such disparate approaches to corticosteroids for COVID-19 pneumonia are lacking. METHODS In this retrospective study of patients admitted to the ICU with COVID-19 pneumonia, we compared patients treated with 0.5-2mg/kg/day in methylprednisolone equivalents (high-dose corticosteroids) and patients treated with 1gm of methylprednisolone (pulse-dose corticosteroids) to those who did not receive any corticosteroids. The endpoints of interest were hospital mortality, ICU-free days at day 28, and complications potentially attributable to corticosteroids. RESULTS Pulse-dose corticosteroid therapy was associated with a significant increase in ICU-free days at day 28 compared to no receipt: aRR 1.45 (95% CI 1.05-2.02; p=0.03) and compared with high-dose corticosteroid administration (p=0.003). Nonetheless, receipt of high-dose corticosteroids-but not of pulse-dose corticosteroids-significantly reduced the odds of hospital mortality compared to no receipt: aOR 0.31 (95% CI 0.12-0.77; p=0.01). High-dose corticosteroids reduced mortality compared to pulse-dose corticosteroids (p=0.04). Pulse-dose corticosteroids-but not high-dose corticosteroids-significantly increased the odds of acute kidney injury requiring renal replacement therapy compared to no receipt: aOR 3.53 (95% CI 1.27-9.82; p=0.02). The odds of this complication were also significantly higher in the pulse-dose group when compared to the high-dose group (p=0.0488 for the comparison). CONCLUSIONS In this single-center study, pulse-dose corticosteroid therapy for COVID-19 pneumonia in the ICU was associated with an increase in ICU-free days but failed to impact hospital mortality, perhaps because of its association with development of severe renal failure. In line with existing trial data, the effect of high-dose corticosteroids on mortality was favorable. This article is protected by copyright. All rights reserved.