Impact of systemic corticosteroids on mortality in older adults with critical COVID-19 pneumonia

Piniella-Ruiz, Esther; Bellver-Álvarez, María Teresa; Mestre-Gómez, Beatriz; Escolano-Fernández, Belén; Vinat-Prado, Sara; Cabezas-Olea, Rita; Acedo-Gutiérrez, María Soledad; Akasbi-Montalvo, Mirian; Ryan-Murua, Pablo; Bustamante-Fermosel, Ana; Muñoz-Rivas, Nuria; Santamaría-García, Carmen; Pardo-Guimerá, Virginia; Ulla-Anés, Mariano; Franco-Moreno, Anabel; Torres-Macho, Juna

BACKGROUND: The most susceptible population group to critical and fatal coronavirus disease 2019 (COVID-19) is older adults. In SARS-CoV-2 infection, the host immune response is thought to play a key role in the pathophysiological effects of lung damage. Therefore, corticosteroid therapy could modulate inflammation-mediated pulmonary injury and thereby reduce progression to severe respiratory failure and death. The aim of this study was to analyse the safety and clinical efficacy of corticosteroid therapy in older adults with severe COVID-19 pneumonia. METHOD: We reviewed the clinical records of confirmed COVID-19 patients aged 75 years or older admitted to our hospital over a three months period (March 1, to May 31, 2020). A total of 143 patients were included in the study cohort. From 2 April, 2020, in accordance with World Health Organization (WHO) guidance on COVID-19, our hospital protocol added corticosteroid for COVID-19 treatment. We compared in-hospital mortality among patients with critical COVID-19 who received corticosteroids therapy and those who did not. RESULTS: 88 patients (61.5%) were treated with corticosteroids, and 55 patients (38.4%) were not. Both groups were similar in baseline characteristics. The median age was 85 years (IQR, 82–89), and 61.5% (88/143) were male. In-hospital mortality was lower in the corticosteroid group (68.2%) compared with patients in the non-corticosteroid group (81.8%). Treatment with corticosteroids was an independent survival factor (HR=0.61; 95% CI, 0.41–0.93; P=0.006). CONCLUSIONS: In critically ill older adults with COVID-19 pneumonia, the use of corticosteroid treatment resulted in lower mortality without severe adverse events.