TY - JOUR T1 - Impact of corticosteroids in hospitalised COVID-19 patients JF - BMJ Open Respiratory Research JO - BMJ Open Resp Res DO - 10.1136/bmjresp-2020-000766 VL - 8 IS - 1 SP - e000766 AU - Kam Sing Ho AU - Bharat Narasimhan AU - Larry Difabrizio AU - Linda Rogers AU - Sonali Bose AU - Li Li AU - Roger Chen AU - Jacqueline Sheehan AU - Maan Ajwad El-Halabi AU - Kimberly Sarosky AU - Zichen Wang AU - Elliot Eisenberg AU - Charles Powell AU - David Steiger Y1 - 2021/04/01 UR - http://bmjopenrespres.bmj.com/content/8/1/e000766.abstract N2 - Background Corticosteroids are a potential therapeutic agent for patients with COVID-19 pneumonia. The RECOVERY (Randomised Trials in COVID-19 Therapy) trial provided data on the mortality benefits of corticosteroids. The study aimed to determine the association between corticosteroid use on mortality and infection rates and to define subgroups who may benefit from corticosteroids in a real-world setting.Methods Clinical data were extracted that included demographic, laboratory data and details of the therapy, including the administration of corticosteroids, azithromycin, hydroxychloroquine, tocilizumab and anticoagulation. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) admission and invasive mechanical ventilation. Outcomes were compared in patients who did and did not receive corticosteroids using the multivariate Cox regression model.Results 4313 patients were hospitalised with COVID-19 during the study period, of whom 1270 died (29.4%). When administered within the first 7 days after admission, corticosteroids were associated with reduced mortality (OR 0.73, 95% CI 0.55 to 0.97, p=0.03) and decreased transfers to the ICU (OR 0.72, 95% CI 0.47 to 1.11, p=0.02). This mortality benefit was particularly impressive in younger patients (<65 years of age), females and those with elevated inflammatory markers, defined as C reactive protein ≥150 mg/L (p≤0.05), interleukin-6 ≥20 pg/mL (p≤0.05) or D-dimer ≥2.0 µg/L (p≤0.05). Therapy was safe with similar rates of bacteraemia and fungaemia in corticosteroid-treated and non-corticosteroid-treated patients.Conclusion In patients hospitalised with COVID-19 pneumonia, corticosteroid use within the first 7 days of admission decreased mortality and ICU admissions with no associated increase in bacteraemia or fungaemia.Data may be obtained from a third party and are not publicly available. Data may be requested from the Mount Sinai COVID Informatics Center (MSCIC) and is not currently publicly available. ER -