Effects of Glucorticosteroids on Coronavirus SARS-CoV 2 In-Patients Mortality; A Retrospective, Cohort Study of Single, High Density COVID-19 Institution in Lombardy, Italy

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Background: A dysregulation of the systemic inflammatory response is a main issue of the SARS-CoV-2 infection. Corticosteroids may suppress this exaggerated inflammatory response, but no evidence has been provided for acute respiratory distress syndrome (ARDS) due to viral pneumonia. We retrospective studied the effects of higher doses of either methylprednisolone or dexamethasone on in-hospital mortality and intensive care (ICU) admission in SARS-CoV-2 patients.Methods: All SARS-CoV-2 infected patients admitted in our institution during the pandemic outbreak in north of Italy were analyzed for demographic data, clinical presentation, medical history, and therapy to assess the effects of a standardized corticosteroids treatment on mortality and ICU admission. Two survival analysis models (overall mortality and ICU admission) were built. Prognostic factors with p values Findings: From March 6, 2020 to May 5, 2020 we analyzed 1063 interstitial pneumonia laboratory confirmed COVID-19 patients. The overall in-hospital mortality was 26 7%. Ninety-nine (9%) patients versus 863 (91%) received the standardized corticosteroids protocol. Four variables were predictive of in-hospital death in the final multivariate model, namely: male gender (HR=1 38; P=0 0121), age (1-yr-HR=1 06; P=0 0001), SpO2 on O2 reservoir-mask (HR=0 97; P=0 0001), and corticosteroid administration (HR=0 10; P=0 0001), while three variables were predictive of ICU admission namely: male gender (HR=2 01; P=0 0006), age (1-yr-HR=0 97; PInterpretation: A standardized use of higher doses of corticosteroids could reduce overall in-hospital mortality in severe COVID-19 patients. This study also confirmed that among COVID-19 patients, male gender and older age are independent risk factors for in-hospital mortality and ICU admission.Funding Statement: There are no funds to declare.Declaration of Interests: No conflict of interest among the authors.Ethics Approval Statement: Due to the retrospective nature of the study no informed consent was required from the patients. A local review board (IRCCS Humanitas, Rozzano, Milan) approved the study.