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. 2020 Dec;9(4):823-836.
doi: 10.1007/s40121-020-00332-3. Epub 2020 Sep 2.

Efficacy Evaluation of Early, Low-Dose, Short-Term Corticosteroids in Adults Hospitalized with Non-Severe COVID-19 Pneumonia: A Retrospective Cohort Study

Qiang Li #  1 , Weixia Li #  2 , Yinpeng Jin #  1 , Wei Xu #  1 , Chenlu Huang #  1 , Li Li  1 , Yuxian Huang  1 , Qingchun Fu  3 , Liang Chen  4
Affiliations

Efficacy Evaluation of Early, Low-Dose, Short-Term Corticosteroids in Adults Hospitalized with Non-Severe COVID-19 Pneumonia: A Retrospective Cohort Study

Qiang Li et al. Infect Dis Ther. 2020 Dec.

Abstract

Objectives: This study aimed to observe the efficacy of corticosteroids in non-severe COVID-19 pneumonia.

Methods: A retrospective study based on propensity score matching was designed to explore the effects of corticosteroids. Primary outcomes included the rate of patients who developed severe disease and mortality. Secondary outcomes included duration of fever, virus clearance time, length of hospital stay, and the use of antibiotics.

Results: A total of 475 patients with non-severe COVID-19 pneumonia were enrolled, 55 patients received early, low-dose, and short-term corticosteroids therapy, 420 patients received non-corticosteroids therapy. Compared to the non-corticosteroids group, there was a prolonged duration of fever (median 5 vs 3 days, p < 0.001), virus clearance time (median 18 vs 11 days, p < 0.001), and length of hospital stay (median 23 vs 15 days, p < 0.001) in the corticosteroids group. The percentages of antibiotics therapy (89.1% vs 23.6%, p < 0.001), use of at least two antibiotics (38.2% vs 12.7%, p = 0.002), and antifungal therapy (7.3% vs 0, p = 0.042) were higher in the corticosteroids group than those in the non-corticosteroids group. Compared to the non-corticosteroids group, more patients developed severe disease (12.7% vs 1.8%, p = 0.028) in the corticosteroids group. There was no significant difference between the two groups in mortality (1.8% vs 0, p = 0.315).

Conclusion: In adult patients with non-severe COVID-19 pneumonia, early, low-dose, and short-term corticosteroids therapy was associated with worse clinical outcomes.

Keywords: 2019 novel coronavirus disease; Corticosteroids; Efficacy evaluation; Non-severe COVID-19 infections; Severe acute respiratory syndrome coronavirus 2.

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Figures

Fig. 1
Fig. 1
Flow diagram of the study population. A total of 664 consecutive patients with COVID-19 were retrospectively analyzed. Finally, 475 patients with non-severe COVID-19 pneumonia were enrolled; among them, 55 patients received methylprednisolone therapy (corticosteroids group) and 420 patients received the standard therapy (non-corticosteroids group). As significant differences existed in baseline characteristics between the corticosteroids group and non-corticosteroids group, 55 pairs were generated according to propensity score matching
Fig. 2
Fig. 2
Cox analysis for comparison of time variables between groups. Cox regression analysis showed significant differences in the virus clearance time (HR 0.419, 95% CI 0.282–0.622, p < 0.001) (a), length of hospital stay (HR 0.443, 95% CI 0.301–0.652, p < 0.001) (b), and the rate of COVID-19 progression to severe disease (HR 2.17, 95% CI 2.01–2.34, p < 0.001) (c) between the corticosteroids group and non-corticosteroids group. There was a significant rise of 10.9% in the severe cases among the recipients of corticosteroids vs non-corticosteroids
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