Ashesha Mechineni, MD
Physician
Univeristy of Illinois At Chicago
Chicago, Illinois
Disclosure information not submitted.
Christopher Millet, MD
Resident
St.Joseph's University Medical Center, United States
Disclosure information not submitted.
Spandana Narvaneni, MD
Resident
St.Joseph's University Medical Center, United States
Disclosure information not submitted.
Sherif Roman, MD
Resident
St.Joseph's University Medical Center, United States
Disclosure information not submitted.
Rajapriya Manickam, MD
Attending
Saint Joseph's University Medical Center, United States
Disclosure information not submitted.
Title: Do high-dose steroids have better outcomes in COVID 19 patients?
Introduction: Therapeutic treatments for COVID 19 disease are under debate since the inception of pandemic. The COVID 19 Recovery trial became a landmark study in which dexamethasone was proven to have a clear mortality benefit in COVID 19 patients, requiring oxygen and mechanical ventilation. Dexamethasone dosing from this trial is adopted as a guideline across healthcare systems for the treatment of COVID 19 patients. Optimal dosage, duration of treatment, and patient selection for this treatment remain unresolved. Our main objective is to assess if patients receiving a higher dose of steroids had better results in terms of mortality, severity classification improvement, and duration of stay.
Methods: We did a retrospective review of all patients between the dates of September 1 to November 30, 2020. We categorized patients as per WHO (World Health Organization) severity classification and then divided patients into low and high-dose steroid categories. The low dose category was defined as equal to or less than dexamethasone 6 mg/day intravenous or methylprednisolone 120 mg/day intravenous per day dosing in one or divided doses. Any dose higher than this limit was considered a high dose. All patients received the doses in the first 48 hours of admission and received for a variable duration of up to 5-10 days based on their clinical progress. The study was approved by the Institutional review board. All appropriate statistical analyses were performed using R studio 1.3.1073.
Results: 371 patients were included in the study. Baseline characteristics and clinical complications were comparable between the groups. All patients groups demonstrated a higher length of stay in the higher steroid dose category. In WHO category 4,5 length of stay difference: 9days vs. 15days with p:0001(-9.6- -3.6). In WHO category 6,7,8 length of stay difference was noted to be 18 days vs 26 days(p:0.03(-16.1- -7.3)) and no difference in in-hospital mortality rate was noted between the steroid dose groups(p:0.69 (0.46-3.05)).
Conclusion: There is no benefit from using high dose corticosteroids in any disease category of patients than the current recommended dose of 6 mg/day dexamethasone for 10 days duration.