Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicenter study

Bartoletti, Michele; Marconi, Lorenzo; Scudeller, Luigia; Pancaldi, Livia; Tedeschi, Sara; Giannella, Maddalena; Rinaldi, Matteo; Bussini, Linda; Valentini, Ilaria; Ferravante, Anna Filomena; Potalivo, Antonella; Marchionni, Elisa; Fornaro, Giacomo; Pascale, Renato; Pasquini, Zeno; Puoti, Massimo; Merli, Marco; Barchiesi, Francesco; Volpato, Francesca; Rubin, Arianna; Saracino, Annalisa; Tonetti, Tommaso; Gaibani, Paolo; Ranieri, Vito Marco; Viale, Pierluigi; Cristini, Francesco

OBJECTIVES: To assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19) METHODS: Multicenter observational study from February 22 through June 30, 2020. We included consecutive adult patients with severe COVID-19 defined as respiratory rate ≥30 breath per minute, oxygen saturation ≤93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ≤300 mmHg. We excluded patients treated with other immunomodulant drugs, receiving low dose of corticosteroids and those receiving corticosteroids after 72h from admission. The primary endpoint was 30-day mortality form hospital admission. The main exposure variable was corticosteroid therapy at dosage of ≥0.5 mg/kg of prednisone equivalents. It was introduced as binomial covariate in a logistic regression model for primary endpoint and inverse probability of treatment weighting using the propensity score. RESULTS: Of 1717 patients with COVID-19 evaluated, 513 patients were included in the study; of these 170 (33%) were treated with corticosteroids. During the hospitalization 166 (34%) patients reached the primary outcome [60/170 (35%) in the corticosteroid group and 106/343 (31%) in the non-corticosteroid group]. At multivariable analysis corticosteroid treatment was not associated with lower 30-day mortality rate [aOR 0.59 (0.20-1.74), p=0.33]. After inverse probability of treatment weighting, corticosteroids were not associated to lower 30-day mortality [average treatment effect 0.05 (95% -0.02 to 0.09), p=0.12]. However, subgroup analysis revealed that in patients with PO(2)/FiO(2) < 200 mmHg at admission [135 patients, 52 (38%) treated with corticosteroids] corticosteroid treatment was associated to a lower risk of 30-day mortality [23/52 (44%) vs 45/83 (54%), aOR 0.20 (95%CI 0.04 to 0.90), p=0.036]. CONCLUSION: Our study shows that the effect of corticosteroid treatment on mortality might be limited to critically ill COVID-19 patients.