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Clinicians may use
glucocorticoids as it may benefit coronavirus disease 2019 (COVID-19)
patients with severe inflammation.
As per findings of a study, published in the Journal of Hospital Medicine, it was concluded that for patients hospitalized with COVID-19 and having elevated levels of inflammation due to the disease, early treatment with glucocorticoids may be advantageous. The observational study was conducted in hospitalized patients with COVID-19 to explore the effect of glucocorticoid therapy on mortality and the need for mechanical ventilation.
The study enrolled 1806 patients, 140 (7.7%) patients were administered glucocorticoids within 48 hours of admission and 1666 patients were not administered steroid therapy (control group). In the treatment group, the majority of patients received prednisone, while some received methylprednisolone or dexamethasone.
The trial illustrated that early glucocorticoid therapy was not linked with either death or mechanical ventilation in patients infected with COVID-19. In patients with an initial C-reactive protein (CRP) level of ≥20mg/dL, treatment with glucocorticoids remarkably diminished the risk of mortality or mechanical ventilation (odds ratio [OR], 0.23; 95% CI, 0.08-0.70). However, in those with an initial CRP level of <10mg/dL, glucocorticoid therapy was found to considerably raise the risk of mechanical ventilation or death (OR, 2.64; 95% CI, 1.39-5.03).
Regardless of race, gender, or ethnicity, the results of this study were found to apply to all patients. These findings also reconfirmed the results procured from a recent large-scale study conducted in the United Kingdom, that is, Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial. The preliminary analysis of the open-label RECOVERY trial illustrated that in hospitalized COVID-19 patients, treatment with dexamethasone was linked with a decline in mortality rates.
The findings of the RECOVERY study were expanded in two pivotal ways. It determined patient groups who are likely to profit (or be impaired) based on CRP, an extensively utilized lab test. In addition to identifying some patients who may benefit, it also identified patient groups that may experience damage from glucocorticoid treatment.
Thus, glucocorticoids may be valuable for COVID-19 patients. Future studies are warranted in COVID-19 infected patients to further understand the role of CRP in guiding treatment with glucocorticoids.
Journal of Hospital Medicine
Effect of Systemic Glucocorticoids on Mortality or Mechanical Ventilation in Patients With COVID-19
Maria J Keller et al.
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