Stephanie Williams, MD
Resident Physician, Florida State University/ Sarasota Memorial Hospital
n/a
Sarasota, Florida
Disclosure information not submitted.
Natalia Lattanzio
Natalia Lattanzio, MD
Florida State University, United States
Disclosure information not submitted.
Richard Walo
Richard Walo Jr. , DO
Florida State University, United States
Disclosure information not submitted.
Karen Hamad, n/a
Karen Hamad, MD
Florida State University College of Medicine, United States
Disclosure information not submitted.
Wilhelmine Wiese-Rometsch
Wilhelmine Wiese-Rometsch, MD
Florida State University, United States
Disclosure information not submitted.
Joseph Seaman
Joseph Seaman, MD
Florida State University, United States
Disclosure information not submitted.
Title: Corticosteroid Treatment Response in Hospitalized COVID-19 Patients
INTRODUCTION: Dose and timing of corticosteroid therapy is uncertain in COVID-19 patients. We compared treatment response in COVID-19 patients receiving steroids for at least two consecutive days versus progression to critical illness (PCI) defined as ICU admission or death.
Methods: After IRB exemption, clinical data were extracted from electronic medical records of COVID-19 patients consecutively admitted between March 10, 2020 and May 31, 2021. Steroid response was defined as change between baseline and last C-reactive protein level within 72h of initial dose. Continuous data summarized with mean [SD] or median [IQR] were compared using t-test or Kruskal-Wallis test. Discrete data summarized as counts or proportions were compared with chi-squared test. Confounders statistically balanced included age, sex, race, comorbidities and remdesivir / tocilizumab treatment.
Results: Among 2153 patients, 644 underwent at least 2d of steroid treatment. Time (h) from presentation to first dose respectively was 4.0[2.0-7.7] vs. 3.6[1.8-7.3] (p=.63) in patient who did not vs. did PCI. Age of 70[58-80] years in 57% males and 43% females was distributed across White (74%), Black (11%), and Other (15%) races with 4[2-6] comorbidities. Steroids included dexamethasone (96%), methylprednisolone (25%), prednisone (11%), and hydrocortisone (7%) in background of remdesivir (52%) and tocilizumab (7%). Baseline assays included CRP 8.9[4.7-14.6] mg/dL; ferritin 509[231-986] ng/mL; LDH 251[331-454] U/L; procalcitonin 0.12[0.05-0.43] ng/mL; D-dimer 0.94[0.57-1.85] mg/mL; and serum glucose 121[104-156] mg/dL. Mean CRP within 24h before vs. last value within 72h of instituting steroids was 9.1[7.2] vs 12.9[8.2] mg/dL (p< .0001) and 7.5[6.0] vs. 10.5[7.6] mg/dL (p< .0001) respectively affecting delta CRP 1.7[5.0] vs. 2.4[6.2] mg/dL (p=.14) in patients who did not vs. did PCI. Delta CRP in patients who did (n=334) vs. did not (n=310) receive remdesivir was 2.1[5.3] vs. 1.8[5.8] mg/dL (p=.53). Delta CRP in patients who did (n=48) vs. did not (n=596) receive tocilizumab was 4.7[7.4] vs. 1.7[5.2] mg/dL (p=.009).
Conclusions: Steroid treatment was associated with a significant reduction in CRP; however, its use did not affect PCI. Steroid response was not impacted by use of remdesivir while augmented with tocilizumab.