Efficacy of Corticosteroids in Non-Intensive Care Unit Patients with COVID-19 Pneumonia from the New York Metropolitan region

Majmundar, Monil; Kansara, Tikal; Lenik, Joanna M; Park, Hansang; Ghosh, Kuldeep; Doshi, Rajkumar; Shah, Palak; Kumar, Ashish; Amin, Hossam; Chaudhari, Shobhana; Habtes, Imnette

Introduction: The role of systemic corticosteroid as a therapeutic agent for patients with COVID19 pneumonia is controversial. Objective: The purpose of this study was to evaluate the effect of corticosteroids in non-intensive care unit (ICU) patients with COVID19 pneumonia complicated by acute hypoxemic respiratory failure (AHRF). Methods: This was a single center retrospective cohort study, comprising of 205 patients admitted to the general wards with COVID19 pneumonia. The primary outcome was a composite of ICU transfer, intubation, or inhospital mortality. Cox proportional hazard regression was implemented. Result: Among 205 patients, 60 (29.27%) were treated with corticosteroid. The mean age was ~57 years, and ~75% were men. Thirteen patients (22.41%) developed a primary composite outcome in the corticosteroid cohort vs. 54 (37.5%) patients in the non-corticosteroid cohort (P=0.039). The adjusted hazard ratio (HR) for the development of the composite primary outcome was 0.15 (95% CI, 0.07 to 0.33; P <0.001). The adjusted hazard ratio for ICU transfer was 0.16 (95% CI, 0.07 to 0.34; P < 0.001), intubation was 0.31 (95% CI, 0.14 to 0.70; P=0.005), death was 0.53 (95% CI, 0.22 to 1.31; P=0.172), and discharge was 3.65 (95% CI, 2.20 to 6.06; P<0.001). The corticosteroid cohort had increasing SpO2/FiO2 over time compared to the non-corticosteroid cohort who experience decreasing SpO2/FiO2 over time. Conclusion: Among non-ICU patients hospitalized with COVID-19 pneumonia complicated by AHRF, treatment with corticosteroid was associated with a significantly lower risk of the primary composite outcome of ICU transfer, intubation, or inhospital death.