Impact Of Intermediate To High Doses Of Methylprednisolone On Mortality Rate In Patients With Covid-19 Pneumonia-Induced Severe Systemic Inflammation

Introduction In addition to respiratory support needs, patients' characteristics to guide indication or timing of corticosteroid treatment in COVID-19 patients are not completely established. This study aimed to evaluate the impact of methylprednisolone on mortality rate in patients with COVID-19 pneumonia-induced severe systemic inflammation (PI-SSI). Methods Between 9 March and 5 May 2020 (final follow-up on 2 July 2020), a retrospective cohort study was conducted in hospitalised patients with COVID-19 PI-SSI (>= 2 inflammatory biomarkers [IBs]: temperature >= 38celcius, lymphocyte <= 800 cell/mu L, C-reactive protein >= 100 mg/L, lactate dehydrogenase >= 300 units/L, ferritin >= 1000 mcg/L, D-dimer >= 500 ng/mL). Patients received 0.5-1.0 mg/kg of methylprednisolone for 5-10 days or standard of care. The primary outcome was 28-day all-cause mortality. Secondary outcomes included >= 2 points improvement on a 7-item WHO-scale (Day 14), transfer to intensive care unit (ICU) (Day 28) and adverse effects. Kaplan-Meier method and Cox proportional hazard regression were implemented to analyse the time to event outcomes. Results A total of 142 patients (corticosteroid group n = 72, control group n = 70) were included. A significant reduction in 28-day all-cause mortality was shown with methylprednisolone in patients with respiratory support (HR: 0.15; 95% CI 0.03-0.71), with >= 3 (HR: 0.17; 95% CI 0.05-0.61) or >= 4 altered IB (HR: 0.15; 95% CI 0.04-0.54) and in patients with both respiratory support and >= 3 (HR: 0.11; 95% CI 0.02-0.53] or >= 4 altered IB (HR: 0.14; 95% CI 0.04-0.51). No significant differences were found in secondary outcomes. Conclusion Intermediate to high doses of methylprednisolone, initiated between 5 and 12 days after symptom onset, was associated with a significant reduction in 28-day all-cause mortality in patients with COVID-19 pneumonia and >= 3 o >= 4 altered IB, independently of the need of respiratory support.