Predictive factors of response to systemic corticosteroids in patients hospitalized with COVID-19 pneumoniae

Abstract

Background: COVID19 pneumonia is probably the most frequent cause of death in this infection. We aimed to identify factors related to favorable response to systemic corticosteroids.

Methods: multicenter retrospective post-hoc study of patients with COVID19 pneumonia who received systemic corticosteroids. Multivariate analysis considering independent variables: age, gender, comorbidities (Charlson index), inflammatory status (by CRP), presence of respiratory failure (SpO2 < 90%), days from symptom onset to corticosteroid prescription, maximum corticosteroid dose, use of corticosteroid bolus and concomitant tocilizumab. Dependent variable was a composite of death and orotracheal intubation (OTI). Optimal cut-off point was obtained from ROC analysis.

Results: 479 patients. Composite outcome was reached in 190(39.6%)cases. Those who reached it were older, with higher comorbidity load, lower SpO2 and higher CRP. They had shorter interval between symptom onset and corticosteroids use. They also received more frequently bolus and tocilizumab. Regarding the multivariable logistic regression analysis: older age, use of bolus and use of tocilizumab were significantly associated with a higher risk to reach the composite outcome, while higher SpO2 and a longer interval from symptoms onset to corticosteroid prescription were associated to a lower risk of reaching the adverse outcome. Best cut-off values to rule-out the composite outcome were:≤ 73 years(95%CI:63–81.2), SaO2:>89%(95%CI:87–89), >9days for time from symptoms onset to corticosteroid treatment(95%CI:5.1–12).

Conclusion: greater mortality benefit in response to corticosteroids if longer duration of symtoms, as Recovery Trial.