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

Cusacovich, I.; Aparisi, A.; Marcos, M.; Ybarra-Falcon, C.; Iglesias-Echevarria, C.; Lopez-Veloso, M.; Barraza-Vengoechea, J.; Duenas, c.; Juarros Martinez, S. A.; Rodriguez-Alonso, B.; Martin-Oterino, J.-A.; Montero-Baladia, M.; Moralejo, L.; Andaluz-Ojeda, D.; Gonzalez-Fuentes, R.

Objectives: To assess the influence of corticosteroid pulses 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. Results: From 2933 patients, 257 fulfilled the inclusion and exclusion criteria. 124 patients were on corticosteroid pulses, and 133 were not. 30,3% (37/122) of patients died in the corticosteroid pulses group and 42,9% (57/133) in the non-exposed cohort. These differences (12,6%) were statically significant (log-rank 4.72, p=0,03). We performed PSM using the exact method. Mortality differences remained in the PSM group (log-rank 5.31, p=0,021) and were still significant after a Cox regression model (HR for corticosteroid pulses 0,561, p= 0,039). There were no significant differences in intensive care admission rate (p=0,173). The hospital stay was longer in the corticosteroid group (p<0,001). Conclusions: 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.