Association between high-dose steroid therapy, respiratory function, and time to discharge in patients with COVID-19: Cohort study

Rodríguez-Molinero, Alejandro; Pérez-López, Carlos; Gálvez-Barrón, César; Miñarro, Antonio; Rodríguez Gullello, Ezequiel A.; Collado Pérez, Isabel; Milà Rà fols, Núria; Mónaco, Ernesto E.; Hidalgo García, Antonio; Añaños Carrasco, Gemma; Chamero Pastilla, Antonio; Alberti Casas, Anna; Avalos Garcia, Jose L.; Borrego Ruiz, Manel; Campo Pisa, Pedro L.; Capielo Fornerino, Ana M.; Dapena, María Dolores; Fenollosa Artes, Andreu M.D.; Gris Ambros, Clara; Hernandez Martinez, Lourdes; López, Gabriela F.; Martín Puig, Mireia; Martínez, Sergi; Macho Pérez, Oscar; Molina Hinojosa, José C.; Peramiquel Fonollosa, Laura; Pisani Zambrano, Italo G.; Rives, Juan P.; Robles, Maria Teresa; Sabria Bach, Enric; Sanchez Rodriguez, Yris M.; Segura Martín, Maria del Mar; Tremosa Llurba, Gemma; Ventosa Gili, Ester; Venturini Cabanellas, Florencia I.; Vidal Meler, Natà lia

Objective To analyze whether there is an association between the use glucocorticoids at high doses, and the evolution of saturation/fraction of inspired oxygen (SAFI) or time to discharge, in patients hospitalized with COVID-19. Methods This was an observational study on a cohort of 418 patients admitted to three regional hospitals in Catalonia, Spain. As primary outcomes, we studied the evolution of SAFI in the first 48 h of treatment and the time to discharge. The results were compared between patients treated and untreated with glucocorticoids (methylprednisolone 1 mg/kg/day o dexamethasone 20–40 mg/day) through sub-cohort analyses matched for multiple clinical and prognostic factors, as well as through Cox multivariate models adjusted for prognostic factors. The simultaneous use of different treatments for COVID-19 was taken into account, both in sub-cohorts matching and in COX regression. Results There were 187 patients treated with glucocorticoids; of these, 25 patients could be matched with an equivalent number of control patients. In the analysis of these matched sub-cohorts, no significant difference was observed in time to discharge (log-rank: p = 0.291) or the increment in SAFI at 48 hours of treatment (glucocorticoides: −0.04; controls: +0.37; p = 0.095). Multivariate models using Cox regression showed a significantly longer time to discharge in patients treated with glucocorticoids (hazard ratio: 7.26; 95% IC: 3.30–15.95). Conclusions We have not found improvement in respiratory function or time until discharge, associated with the use of glucocorticoids at high doses.