Determinants of the protective effect of glucocorticoids on mortality in hospitalized patients with COVID-19

• Published in: International journal of infectious diseases Vol. 108; pp. 270 - 273
• Main Authors: Pagnesi, Matteo, Inciardi, Riccardo M., Lombardi, Carlo M., Agostoni, Piergiuseppe, Ameri, Pietro, Barbieri, Lucia, Bellasi, Antonio, Camporotondo, Rita, Canale, Claudia, Carubelli, Valentina, Carugo, Stefano, Catagnano, Francesco, Dalla Vecchia, Laura A., Danzi, Gian Battista, Di Pasquale, Mattia, Gaudenzi, Margherita, Giovinazzo, Stefano, Gnecchi, Massimiliano, Guazzi, Marco, Iorio, Annamaria, La Rovere, Maria Teresa, Leonardi, Sergio, Maccagni, Gloria, Mapelli, Massimo, Margonato, Davide, Merlo, Marco, Monzo, Luca, Mortara, Andrea, Nuzzi, Vincenzo, Piepoli, Massimo, Porto, Italo, Pozzi, Andrea, Sarullo, Filippo, Sinagra, Gianfranco, Tedino, Chiara, Tomasoni, Daniela, Volterrani, Maurizio, Zaccone, Gregorio, Senni, Michele, Metra, Marco
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.07.2021; Elsevier
• Subjects: Corticosteroid; COVID-19; Glucocorticoid; SARS-CoV-2; Steroid; COVID-19; Steroid; Corticosteroid; SARS-CoV-2; Glucocorticoid
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2021.05.056

•Glucocorticoids are an effective therapy for patients hospitalized with COVID-19.•The use of glucocorticoids was associated with a lower risk of in-hospital mortality.•A protective effect was mainly observed in patients with worse respiratory parameters. Glucocorticoid therapy has emerged as an effective therapeutic option in hospitalized patients with coronavirus disease 2019 (COVID-19). This study aimed to focus on the impact of relevant clinical and laboratory factors on the protective effect of glucocorticoids on mortality. A sub-analysis was performed of the multicenter Cardio-COVID-Italy registry, enrolling consecutive patients with COVID-19 admitted to 13 Italian cardiology units between 01 March 2020 and 09 April 2020. The primary endpoint was in-hospital mortality. A total of 706 COVID-19 patients were included (349 treated with glucocorticoids, 357 not treated with glucocorticoids). After adjustment for relevant covariates, use of glucocorticoids was associated with a lower risk of in-hospital mortality (adjusted HR 0.44; 95% CI 0.26–0.72; p = 0.001). A significant interaction was observed between the protective effect of glucocorticoids on mortality and PaO2/FiO2 ratio on admission (p = 0.042), oxygen saturation on admission (p = 0.017), and peak CRP (0.023). Such protective effects of glucocorticoids were mainly observed in patients with lower PaO2/FiO2 ratio (<300), lower oxygen saturation (<90%), and higher CRP (>100 mg/L). The protective effects of glucocorticoids on mortality in COVID-19 were more evident among patients with worse respiratory parameters and higher systemic inflammation.