Effect of Corticosteroids on Mortality in Hospitalized COVID-19 Patients Not Receiving Invasive Mechanical Ventilation

Federica Fusina, Filippo Albani, Enza Granato, Angelo Meloni, Renzo Rozzini, Tony Sabatini, Roberto Stellini, Paolo Terragnoli, Antonio Rosano, Mohammed Abu Hilal, Giuseppe Natalini

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The most beneficial effect of corticosteroid therapy in COVID-19 patients has been shown in subjects receiving invasive mechanical ventilation (IMV), corresponding to a score of 6 on the World Health Organization (WHO) COVID-19 Ordinal Scale for Clinical Improvement (OSCI). The aim of this observational, single-center, prospective study was to assess the association between corticosteroids and hospital mortality in coronavirus disease 2019 (COVID-19) patients who did not receive IMV (OSCI 3-5). Included were 1,311 COVID-19 patients admitted to nonintensive care wards, and they were divided in two cohorts: (i) 480 patients who received corticosteroid therapy and (ii) 831 patients who did not. The median daily dose was of 8 mg of dexamethasone or equivalent, with a mean therapy duration of 5 (3-9) days. The indication to administer or withhold corticosteroids was given by the treating physician. In-hospital mortality was similar between the two cohorts after adjusting for possible confounders (adjusted odds ratio (ORadj) 1.04, 95% confidence interval (CI), 0.81-1.34, P = 0.74). There was also no difference in Intensive Care Unit (ICU) admission (ORadj 0.81, 95% CI, 0.56-1.17, P = 0.26). COVID-19 patients with noninvasive mechanical ventilation (NIMV) had a lower risk for ICU admission if they received steroid therapy (ORadj 0.58, 95% CI, 0.35-0.94, P = 0.03). In conclusion, corticosteroids were overall not associated with a difference in hospital mortality for patients with COVID-19 with OSCI 3-5. In the subgroup of patients with NIMV (OSCI 5), corticosteroids reduced ICU admission, whereas the effect on mortality requires further studies.

Original languageEnglish
Pages (from-to)1660-1667
Number of pages8
JournalClinical Pharmacology and Therapeutics
Issue number6
Publication statusPublished - Jun 2021


  • Adrenal Cortex Hormones/administration & dosage
  • Aged
  • Aged, 80 and over
  • COVID-19 Drug Treatment
  • COVID-19/mortality
  • Female
  • Hospital Mortality/trends
  • Humans
  • Intensive Care Units/statistics & numerical data
  • Male
  • Middle Aged
  • Prospective Studies
  • Respiration, Artificial/statistics & numerical data
  • Retrospective Studies
  • SARS-CoV-2
  • Sex Factors

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