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Corticosteroids for COVID‐19 patients requiring oxygen support? Yes, but not for everyone: Effect of corticosteroids on mortality and intensive care unit admission in patients with COVID‐19 according to patients' oxygen requirements
Author(s) -
Tortajada Cecilia,
Colomer Enrique,
AndreuBallester Juan C.,
Esparcia Ana,
Oltra Carmina,
Flores Juan
Publication year - 2021
Publication title -
journal of medical virology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.782
H-Index - 121
eISSN - 1096-9071
pISSN - 0146-6615
DOI - 10.1002/jmv.26635
Subject(s) - medicine , fraction of inspired oxygen , methylprednisolone , intensive care unit , hazard ratio , oxygen therapy , dexamethasone , retrospective cohort study , proportional hazards model , clinical endpoint , anesthesia , mechanical ventilation , emergency medicine , intensive care medicine , randomized controlled trial , confidence interval
Corticosteroids reduce mortality in hospitalized patients with coronavirus disease 2019 (COVID‐19), but the response seems to vary according to the level of respiratory support needed. This retrospective cohort study included COVID‐19 patients with oxygen saturation (SatO 2 ) in room air <92% admitted between March 3 and April 30, 2020. Following the interim protocol, patients could receive dexamethasone or methylprednisolone, and were classified according to oxygen requirements. The primary endpoint was admission to the intensive care unit (ICU) or mortality. Kaplan–Meier and Cox hazards analyses were used. Of the 115 patients included, 38 received corticosteroids. Among requiring high‐flow, noninvasive ventilation (NIV) or fraction of inspired oxygen (FiO 2 ) > 0.40, the hazard ratio (HR) for death or ICU admission, between the corticosteroids and non‐corticosteroids group, was 0.07 (95% CI 0.01–0.4), p = .002, and for patients requiring low‐flow oxygen, the HR was 0.70 (95% CI 0.13–3.8), p = .68. Significant differences were also observed when all patients were analyzed together. A significant reduction in mortality and ICU admission frequency was observed among patients requiring high‐flow oxygen or NIV, but not among those requiring low‐flow oxygen. Better targeting of COVID‐19 patients is needed for the beneficial use of corticosteroids.