Pulse steroid treatment for hospitalized adults with COVID-19

Abstract

High-dose steroid has been shown to reduce the mortality rate in Corona virus disease 2019 (COVID-19) patients who need oxygen support. Here, we evaluated the effectiveness of pulse-steroid in case of unresponsiveness to treatment with high dose steroid. The study is a retrospective controlled trial. We divided the patients in 3 groups: standard-care therapy alone, high-dose steroid treatment (6 mg/day dexamethasone equivalent), and pulse-steroid treatment (250 mg/day methyl-prednisolone). One hundred and fifty patients were enrolled in each group. All patients were hospitalized and needed oxygen support. We matched the patients according to disease severity at the onset of hypoxia, weight of co-morbidities, age, and sex. We then compared 3 groups in terms of mortality, length of hospitalization, need for intensive care unit (ICU) admission and mechanical ventilation (MV), length of stay in ICU, and duration of MV. The pulse-steroid group had shorter ICU stay. The median ICU stay was 9.0 (CI 95% 6.0–12.0) days in standard-care group, 8.0 (CI 95% 5.0–13.0) days in high-dose steroid group and 4.5(CI %95 3.0–8.0) days in pulse-steroid group. Moreover, although patients in pulse-steroid group were initially unresponsive to high dose steroid therapy, they achieved similar results compared to the high-dose steroid group in other outcomes except for length of hospital stay. Pulse-steroid treatment would be an option for COVID-19 patients who do not respond to the initial high-dose steroid treatment.