Comparison of Pulse-Dose and High-Dose Corticosteroids With No Corticosteroid Treatment for COVID-19 Pneumonia in the Intensive Care Unit

Authors

Hamid Yaqoob, Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, New York, USA.
Daniel Greenberg, Department of Medicine, Westchester Medical Center, Valhalla, New York, USA.
Frank Hwang, New York Medical College, Valhalla, New York, USA.
Curtis Lee, New York Medical College, Valhalla, New York, USA.Follow
David Vernik, New York Medical College, Valhalla, New York, USA.
Ravi Manglani, Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, New York, USA.
Zhen Wang, Evidence-Based Practice Center, Mayo Clinic, Rochester, New York, USA.
M Hassan Murad, Evidence-Based Practice Center, Mayo Clinic, Rochester, New York, USA.
Dipak Chandy, Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, New York, USA.Follow
Oleg Epelbaum, Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, New York, USA.Follow

Author Type(s)

Faculty

DOI

10.1002/jmv.27351

Journal Title

Journal of Medical Virology

First Page

349

Last Page

356

Document Type

Article

Publication Date

1-1-2022

Department

Medicine

Abstract

Corticosteroid dosing in the range of 0.5-2 mg/kg/day of methylprednisolone equivalents has become a standard part of the management of intensive care unit (ICU) patients with COVID-19 pneumonia based on positive results of randomized trials and a meta-analysis. Alongside such conventional dosing, administration of 1 gm of methylprednisolone daily (pulse dosing) has also been reported in the literature with claims of favorable outcomes. Comparisons between such disparate approaches to corticosteroids for Coronavirus disease 2019 (COVID-19) pneumonia are lacking. In this retrospective study of patients admitted to the ICU with COVID-19 pneumonia, we compared patients treated with 0.5-2 mg/kg/day in methylprednisolone equivalents (high-dose corticosteroids) and patients treated with 1 gm of methylprednisolone (pulse-dose corticosteroids) to those who did not receive any corticosteroids. The endpoints of interest were hospital mortality, ICU-free days at Day 28, and complications potentially attributable to corticosteroids. Pulse-dose corticosteroid therapy was associated with a significant increase in ICU-free days at Day 28 compared to no receipt: adjusted relative risk (aRR): 1.45 (95% confidence interval [CI]: 1.05-2.02; p = 0.03) and compared with high-dose corticosteroid administration (p = 0.003). Nonetheless, receipt of high-dose corticosteroids-but not of pulse-dose corticosteroids-significantly reduced the odds of hospital mortality compared to no receipt: adjusted Odds ratio (aOR) 0.31 (95% CI: 0.12-0.77; p = 0.01). High-dose corticosteroids reduced mortality compared to pulse-dose corticosteroids (p = 0.04). Pulse-dose corticosteroids-but not high-dose corticosteroids-significantly increased the odds of acute kidney injury requiring renal replacement therapy compared to no receipt: aOR 3.53 (95% CI: 1.27-9.82; p = 0.02). The odds of this complication were also significantly higher in the pulse-dose group when compared to the high-dose group (p = 0.05 for the comparison). In this single-center study, pulse-dose corticosteroid therapy for COVID-19 pneumonia in the ICU was associated with an increase in ICU-free days but failed to impact hospital mortality, perhaps because of its association with development of severe renal failure. In line with existing trial data, the effect of high-dose corticosteroids on mortality was favorable.

Recommended Citation

Yaqoob, H., Greenberg, D., Hwang, F., Lee, C., Vernik, D., Manglani, R., Wang, Z., Murad, M. H., Chandy, D., & Epelbaum, O. (2022). Comparison of Pulse-Dose and High-Dose Corticosteroids With No Corticosteroid Treatment for COVID-19 Pneumonia in the Intensive Care Unit. Journal of Medical Virology, 94 (1), 349-356. https://doi.org/10.1002/jmv.27351