CORTICOSTEROID TREATMENT IN PATIENTS WITH SEVERE COVID-19 PNEUMONIA

SESSION TITLE: Lessons from the ICU: What have We Learned about the Management of COVID-19 SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: SARS-CoV2 is known for causing atypical pneumonia with rapidly progressive respiratory failure requiring intubation Usage of steroids have been shown to be of benefit in similar disease processes caused by other coronaviruses specifically SARS/MERS Currently in the literature there is lack of consensus regarding steroids use in severely ill patients with COVID-19 pneumonia We conducted a retrospective analysis to evaluate the efficacy of systemic corticosteroids and outcomes in COVID-19 patients with severe respiratory symptoms requiring ICU admission in a community hospital in Michigan METHODS: This retrospective cohort study was conducted with 181 patients of COVID-19 with severe respiratory symptoms requiring ICU admission in a community hospital in Michigan March 18 to April 15, 2020 Patients were then divided into 2 groups, with or without steroid treatment Treatment group received oral prednisone, doses range from 10 to 60mg twice daily for an average of 5 days, most of which received a loading dose of intravenous methylprednisolone The primary outcome for the study was mortality rate, secondary outcome was extubation rate RESULTS: 177 patients met inclusion criteria and among those, 93 patients received systemic steroids Of the total 93 patients in the treatment group, 42 patients were admitted to ICU, 38 of which were intubated Of the total 84 patients in the control group, 14 patients were admitted to ICU and 10 were intubated The mortality rate was 53% in the treatment group compared to 57% in the control group (p>0 05);the extubation rate was 71% in the treatment group compared to 50% in the control group (p>0 05) Our results showed a clinically important difference between the two groups CONCLUSIONS: Existing evidence from literature is inconclusive regarding use of steroids in COVID-19 Currently, Surviving Sepsis Campaign recommends using low-dose corticosteroid in intubated COVID-19 patients with ARDS, IDSA guidelines recommend use of steroid only in the setting of clinical trials, and National institutes of Health states that there is insufficient evidence for or against use of steroid in COVID-19 patients Multiple retrospective cohort studies have shown variability in the benefit of steroid use in patients infected with SARS/MERS, which may not be applicable to COVID-19 patients Our study indicates that in severely ill patients with COVID-19, systemic steroids with short-term application was associated with lower ICU mortality rates and higher extubation rates CLINICAL IMPLICATIONS: Though our results did not achieve statistical significance, it was observed that there was an improved mortality rate and increased extubation rate in those who received corticosteroid We suggest further studies, in form of a multi-center randomized control trial to assess additional benefits of systemic steroids in COVID-19 treatment DISCLOSURES: No relevant relationships by Radha Kishan Adusumilli, source=Web Response No relevant relationships by Laith Al-janabi, source=Web Response No relevant relationships by Padmini Giri, source=Web Response No relevant relationships by Gloria Hong, source=Web Response No relevant relationships by Sarwan Kumar, source=Web Response No relevant relationships by Manishkumar Patel, source=Web Response No relevant relationships by Bernadette Schmidt, source=Web Response No relevant relationships by Jurgena Tusha, source=Web Response