Determinants of the protective effect of glucocorticoids on mortality in hospitalized patients with COVID-19: Insights from the Cardio-COVID-Italy multicenter study

Pagnesi, Matteo; Inciardi, Riccardo M.; Lombardi, Carlo Mario; Agostoni, Piergiuseppe; Ameri, Pietro; Barbieri, Lucia; Bellasi, Antonio; Camporotondo, Rita; Canale, Claudia; Carubelli, Valentina; Carugo, Stefano; Catagnano, Francesco; Vecchia, Laura A. Dalla; Danzi, Gian Battista; Di Pasquale, Mattia; Gaudenzi, Margherita; Giovinazzo, Stefano; Gnecchi, Massimiliano; Guazzi, Marco; Iorio, Annamaria; La Rovere, Maria Teresa; Leonardi, Sergio; Maccagni, Gloria; Mapelli, Massimo; Margonato, Davide; Merlo, Marco; Monzo, Luca; Mortara, Andrea; Nuzzi, Vincenzo; Piepoli, Massimo; Porto, Italo; Pozzi, Andrea; Sarullo, Filippo; Sinagra, Gianfranco; Tedino, Chiara; Tomasoni, Daniela; Volterrani, Maurizio; Zaccone, Gregorio; Senni, Michele; Metra, Marco

BACKGROUND: Glucocorticoid therapy has emerged as an effective therapeutic option in hospitalized patients with coronavirus disease 2019 (COVID-19). Our aim was to focus on the impact of relevant clinical and laboratory factors on the protective effect of glucocorticoids on mortality. METHODS: We performed a sub-analysis of the multicenter Cardio-COVID-Italy registry, enrolling consecutive patients with COVID-19 admitted to 13 Italian cardiology units between March 1(st), 2020, and April 9(th), 2020. The primary endpoint was in-hospital mortality. RESULTS: A total of 706 COVID-19 patients were included (n = 349 treated with glucocorticoids, n = 357 not treated with glucocorticoids). After adjustment for relevant covariates, use of glucocorticoids was associated with a lower risk of in-hospital mortality (adjusted HR 0.44, 95% CI 0.26-0.72, p = 0.001). A significant interaction was observed between the protective effect of glucocorticoids on mortality and PaO(2)/FiO(2) ratio on admission (p = 0.042), oxygen saturation on admission (p = 0.017), and peak CRP (0.023). Such protective effect of glucocorticoids was mainly observed in patients with lower PaO(2)/FiO(2) ratio (<300), lower oxygen saturation (<90%), and higher CRP (>100 mg/L). CONCLUSIONS: The protective effects of glucocorticoids on mortality in COVID-19 was more evident among patients of worse respiratory parameters and higher systemic inflammation.