Retrospective evaluation of high dose systemic steroids therapy on mortality of hospitalized COVID pneumonia patients

Abstract

Results from RECOVERY trial showed effect of 6 mg of dexamethasone, despite it we observed high mortality. We therefore used higher than recommended doses of steroids in severe and rapidly progressive COVID patients in January 2021. In this study we retrospectively evaluated effect of total dose of given systemic steroids on mortality in 92 consecutively admitted patients in January 2021 for COVID pneumonia to Pulmonary Dept. of University Hospital. Average age was 70,6±12,8, 44 (47%) females, 48 (53%) males, average BMI 29,6±2,4, clinical frailty score 3,7±2,1, Charleson Comorbidity Index 4,0±3,3, average blood oxygen saturation od admittance was 88,0%±7,1, average breath rate 20,1±11, CRP 123,3±62,7 mg/L, average length of stay was 19,0±13,0. Totally 40 (43,5%) required an ICU care during the stay in the hospital. Mortality was 17,3% (16 of 93 patients died).). Length of the stay correlated to severity of the COVID according to WHO classification (p<0.001, R= 0.50). During the stay in the hospital 21 patients were dependent on HFNO (22,8%), 8 patients required NIV support (8,7%) and 8 (8,7%) patients were intubated. Systemic steroids were given to 85 patients (92,4%) patients. Average daily dose of steroids was 22,4 mg of dexamethasone (DX) (95%CI 16.2-28.6), mean total dose of DX per whole hospital stay was 212.5 mg (95%CI 152.4-272.1). Length of the stay who died was significantly longer (23.5 vs 15.1 days, p=0.01). We used significantly higher total dose of steroids in patients who later died on COVID (p<0.001). Average dose of total steroids given during hospital stay was 377 mg of dexamethasone (95%CI, 252-501) in those who died, and 172mg (95%CI, 106-238). We did not observe clinical impact of high dose steroids on mortality of COVID pneumonia patients.