What We Learned from Steroid Therapy in the COVID‑19 Pandemic

Abstract

Background: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a pandemic named coronavirus  disease 2019 (COVID-19) that has become the greatest worldwide public health threat. Although different treatment recommendations  are offered for COVID‑19 infection, steroid treatment remains important.

Aim: We aimed to demonstrate the effect of pulse steroid therapy (PST) on inflammatory markers and patient outcomes in moderate/severe COVID-19 pneumonia.

Materials and Methods: We  retrospectively analyzed the patients 18 years and older hospitalized in our hospital’s COVID-19 clinics between April 1, 2020, to June 30,  2020, and July 1, 2021, to November 30, 2021. Patients in the moderate/severe COVID-19 pneumonia category, according to the World  Health Organization COVID-19 guidelines, were included in the study. The demographic characteristics of the patients, treatments,  inflammatory markers, and patient outcomes (need for intensive care, length of hospital stay, high‑flow nasal oxygen (HFNO)  requirement, mechanical ventilation (MV), and mortality rates) were recorded and analyzed.

Results: Patients who received PST had  more advanced age (P < 0.01), more comorbidities (P < 0.001), and more HFNO need (P < 001) compared with the patients who did not  receive PST. There was no statistically significant difference between clinical outcomes: the need for intensive care, length of hospital  stay, need for MV, and mortality rates (P = 0.54, P = 0.3, P = 0.14, and P = 0.09, respectively). When we evaluated the unvaccinated patients,  there was a statistically significant difference in the MV need and mortality rates between those who received PST and those  who did not (P = 0.017, P = 0.014, respectively).

Conclusion: It was observed that PST provided similar mortality, ICU, and MV  requirements in patients with older age and comorbidities. Lower MV requirements and mortality were observed in the unvaccinated  group receiving PST compared with the unvaccinated group not receiving steroids. PST is still promising in COVID-19 infection, and more  studies are needed for standard doses and applications.