Association between high-dose steroid therapy, respiratory function, and time to discharge in patients with COVID-19: Cohort study

Alejandro Rodríguez-Molinero, Carlos Pérez-López, César Gálvez-Barrón, Antonio Miñarro, Ezequiel A Rodríguez Gullello, Isabel Collado Pérez, Núria Milà Ràfols, Ernesto E Mónaco, Antonio Hidalgo García, Gemma Añaños Carrasco, Antonio Chamero Pastilla, group of researchers for COVID-19 of the Consorci Sanitari de l’Alt Penedès i Garraf (CSAPG), Alejandro Rodríguez-Molinero, Carlos Pérez-López, César Gálvez-Barrón, Antonio Miñarro, Ezequiel A Rodríguez Gullello, Isabel Collado Pérez, Núria Milà Ràfols, Ernesto E Mónaco, Antonio Hidalgo García, Gemma Añaños Carrasco, Antonio Chamero Pastilla, group of researchers for COVID-19 of the Consorci Sanitari de l’Alt Penedès i Garraf (CSAPG)

Abstract

Objective: To analyze whether there is an association between the use glucocorticoids at high doses, and the evolution of saturation/fraction of inspired oxygen (SAFI) or time to discharge, in patients hospitalized with COVID-19.

Methods: This was an observational study on a cohort of 418 patients admitted to three regional hospitals in Catalonia, Spain. As primary outcomes, we studied the evolution of SAFI in the first 48 h of treatment and the time to discharge. The results were compared between patients treated and untreated with glucocorticoids (methylprednisolone 1 mg/kg/day o dexamethasone 20-40 mg/day) through sub-cohort analyses matched for multiple clinical and prognostic factors, as well as through Cox multivariate models adjusted for prognostic factors. The simultaneous use of different treatments for COVID-19 was taken into account, both in sub-cohorts matching and in COX regression.

Results: There were 187 patients treated with glucocorticoids; of these, 25 patients could be matched with an equivalent number of control patients. In the analysis of these matched sub-cohorts, no significant difference was observed in time to discharge (log-rank: p = 0.291) or the increment in SAFI at 48 h of treatment (glucocorticoides: -0.04; controls: +0.37; p = 0.095). Multivariate models using Cox regression showed a significantly longer time to discharge in patients treated with glucocorticoids (hazard ratio: 7.26; 95% IC: 3.30-15.95).

Conclusions: We have not found improvement in respiratory function or time until discharge, associated with the use of glucocorticoids at high doses.

Keywords: COVID-19; Coronavirus; Dexamethasone; Glucocorticoids; Methylprednisolone; SARS-CoV-2.

© 2020 Elsevier España, S.L.U.

Figures

Fig. 1
Fig. 1
Kaplan-Meier comparison curves and log-rank test of the different subcohorts of patients studied. HCL: hydroxychloroquine; L/R: lopinavir-ritonavir.

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