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High versus standard doses of corticosteroids in severe COVID-19: a retrospective cohort study

2020; Springer Science+Business Media; Volume: 40; Issue: 4 Linguagem: Inglês

10.1007/s10096-020-04078-1

1435-4373

Enric Monreal, Susana Sainz de la Maza, Elena Natera‐Villalba, Álvaro Beltrán‐Corbellini, Fernando Rodríguez‐Jorge, José Ignacio Fernández-Velasco, Paulette Esperanza Walo-Delgado, Alfonso Muriel, Javier Zamora, Araceli Alonso‐Cánovas, Jesús Fortün, Luís Manzano, Beatriz Montero‐Errasquín, Lucienne Costa‐Frossard, Jaime Masjuán, Luisa María Villar, Luis Máiz‐Carro, E. M. Sánchez-García, Francisco Hidalgo, A. Domínguez, José A. Pérez‐Molina, O. Sánchez-Sánchez, Belén Comeche, Begoña Monge‐Maíllo, Esther Barbero, Ignacio Barbolla-Díaz, L. Aranzábal Orgaz, J. Cobo, I Rayo, Covadonga Fernández‐Golfín, E. González, Leonardo Mejia Rincon, Raquel Ron, Beatriz Muñoz, Enrique Navas, Julian Mauricio Moreno, Joshua Norman, Sergio E. Serrano, Carmen Quereda Rodríguez-Navarro, A. Vallés, Sabina Herrera, Jesús Mateos‐Nozal, M. Cobo, Francesca Gioia, M. C. Concejo-Badorrey, Ernest Barraza, Asunción Moreno, Sandra Chamorro, José L. Casado, Carlos Almonacid, Rosa Nieto, Sergio Diz, Elena Moreno, Marisa Martín, J M Hermida, María Concepción García, Juan Luis Chico‐García, Álvaro Beltrán‐Corbellini, Enrique Rodríguez de Santiago, Claudia Geraldine Rita, Ignacio Iturrieta-Zuazo, Ane Andrés, M. Espiño, Mónica Vázquez‐Calatayud, Milagros Fernández Lucas, Javier Martínez‐Sanz, Nuria García‐Barragán, Javier Buisán, Rafael Toledano, Paula Pérez‐Torre, María Consuelo Matute-Lozano, José Luis López-Sendón, Guillermo García‐Ribas, Íñigo Corral, Luisa María Villar,

Adrenal Hormones and Disorders

Despite the increasing evidence of the benefit of corticosteroids for the treatment of moderate-severe coronavirus disease 2019 (COVID-19) patients, no data are available about the potential role of high doses of steroids for these patients. We evaluated the mortality, the risk of need for mechanical ventilation (MV), or death and the risk of developing a severe acute respiratory distress syndrome (ARDS) between high (HD) and standard doses (SD) among patients with a severe COVID-19. All consecutive confirmed COVID-19 patients admitted to a single center were selected, including those treated with steroids and an ARDS. Patients were allocated to the HD (≥ 250 mg/day of methylprednisolone) of corticosteroids or the SD (≤ 1.5 mg/kg/day of methylprednisolone) at discretion of treating physician. Five hundred seventy-three patients were included: 428 (74.7%) men, with a median (IQR) age of 64 (54–73) years. In the HD group, a worse baseline respiratory situation was observed and male gender, older age, and comorbidities were significantly more common. After adjusting by baseline characteristics, HDs were associated with a higher mortality than SD (adjusted OR 2.46, 95% CI 1.59–3.81, p < 0.001) and with an increased risk of needing MV or death (adjusted OR 2.35, p = 0.001). Conversely, the risk of developing a severe ARDS was similar between groups. Interaction analysis showed that HD increased mortality exclusively in elderly patients. Our real-world experience advises against exceeding 1–1.5 mg/kg/day of corticosteroids for severe COVID-19 with an ARDS, especially in older subjects. This reinforces the rationale of modulating rather than suppressing immune responses in these patients.