Administration of systemic steroids during hospitalization does not improve the clinical outcome in patients with Covid-19

The systemic steroids are recommended for cases with refractory septic shock or severe acute respiratory distress syndrome. Although systemic glucocorticoids help to resolve inflammation and treat cytokine storm, the time course for steroid use and which patients benefit from using systemic corticosteroids is unclear. In this study, we aimed to evaluate the therapeutic effect of corticosteroids in COVID-19 patients. Electronic medical records of hospitalized patients (n=7,980) from 178 hospitals across United States for confirmed COVID-19 between January 1st 2020 and May 8th 2020 were reviewed. Of the 7,980 patients, 3,951 (49.5%) were female and 4,029 (50.5%) were male. The mean age was 57.4 +/- 19 years. Fifteen percent (n=1,219) died in hospital or were discharged to hospice care. Seventy-two percent (n=5,774) required non-ICU level of care, while 28% (n=2,206) of patients required ICU, and of those 1,157 (14.5%) needed ventilator support. The mean length of stay in the hospital was 6 days (range 0 - 84 days). Fourteen percent (n=1111) of patients received at least one dose of systemic steroids during hospitalization. Sixty precent of those had ICU level of care with 435 (39%) requiring ventilator support. Overall, the use of corticosteroids was associated with increased mortality (OR=1.273; p=0.0160) and 3.53 days longer hospital stay (p<0.0001). The corticosteroid exposed group was also noted to progress to a higher level of care and have longer time on a ventilator when compared with the patients who did not receive steroids. The length of hospital stay and mortality was higher especially in severe/critical patients. Based on these results, we recommend cautious use of corticosteroids in COVID-19. The etiology behind this association is still unclear and presents an area for future research.