Corticosteroid Use in Severely Hypoxemic COVID-19 Patients: An Observational Cohort Analysis of Dosing Patterns and Outcomes in the Early Phase of the Pandemic

Rahman, O.; Trigonis, R. A.; Craft, M. K.; Kruer, R. M.; Miller, E. M.; Terry, C. L.; Persaud, S. A.; Kapoor, R.

INTRODUCTION Hypoxemia in Severe Acute Respiratory Syndrome due to Novel Coronavirus of 2019 (SARS-CoV-2) is mediated by severe inflammation that may be mitigated by corticosteroids. We evaluated pattern and effects of corticosteroid use in these patients during an early surge of the pandemic. METHODS Observational study of 136 SARS-CoV-2 patients admitted to the Intensive care Unit between March 1 and April 27, 2020 at a tertiary care hospital in Indianapolis, USA. Statistical comparison between cohorts and dosing pattern analysis was done. Outcome measures included number of patients requiring intubation, duration of mechanical ventilation, length of ICU stay and inpatient mortality. RESULTS: Of 136 patients, 72 (53%) received corticosteroids. Groups demographics: Age (60.5 vs. 65; p .083), sex (47% male vs. 39% female; p .338) and comorbidities were similar. Corticosteroid group had increased severity of illness: PaO2/FiO2 (113 vs. 130; p .014) and SOFA (8 vs. 5.5; p < .001). Overall mortality (21% vs. 30%; p .234) or proportion of patients intubated (78 vs. 64%; p .078) was similar. Mortality was similar among mechanically ventilated (27% vs. 15%; p .151) however there were no deaths among patients who were not mechanically ventilated and received corticosteroids (0% vs. 57%; p <.001). Early administration (within 48 hours) showed decrease in proportion of intubation (66% vs. 87 vs. 100%; p.045), ICU days (6 vs., 16 vs. 18; p <.001), and ventilator days (3 vs. 12 & 14; p <.001). 45% received methylprednisolone. CONCLUSION: Corticosteroids were used more frequently in SARS CoV-2 patients with higher severity of illness. Early administration of corticosteroids improved survival in non-mechanically ventilated patients; decreased ICU stay and may have prevented intubation.