Title:Whether Early Steroid dose is Associated with Lower Mortality in
COVID-19 Critically Ill Patients-An Exploratory Chart Review
Volume: 18
Issue: 1
Author(s): Abhishek Goyal*, Ankur Joshi, Saurabh Saigal, Dodda Brahmam, Yogesh Niwariya, Alkesh Khurana, Sagar Khadanga and Arun Mitra
Affiliation:
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhopal, India
Keywords:
COVID-19, ARDS, pulse steroids, mortality, methyl prednisolone, ICU, steroids.
Abstract:
Introduction: Steroids have shown its usefulness in critically ill COVID-19 patients.
However, the time of starting steroid and dose tailored to severity remain a matter of
inquiry due to still emerging evidences and wide-ranging concerns of benefits and harms.
We did a retrospective record analysis in an apex teaching hospital ICU setting to explore
optimal doses and duration of steroid therapy which can decrease mortality.
Methods: 114 adults with COVID-19-ARDS admitted to ICU between 20th March-15th
August 2020 were included in chart review. We did preliminary exploratory analysis (rooted
in steroid therapy matrix categorized by dose and duration) to understand the effect of
several covariates on survival. This was followed by univariate and multivariate Cox proportion
hazard regression analysis and model diagnostics.
Results: Exploratory analysis and visualization indicated age, optimal steroid, severity
(measured in P/F) of disease and infection status as potential covariates for survival. Univariate
cox regression analysis showed significant positive association of age > 60 years
{2.6 (1.5-4.7)} and protective effect of optimum steroid {0.38(0.2-0.72)} on death (hazard)
in critically ill patients. Multivariate cox regression analysis after adjusting effect of age
showed protective effect of optimum steroid on hazard defined as death {0.46(0.23-0.87),
LR = 17.04, (p = 2e-04)}. The concordance was 0.70 and model diagnostics fulfilled the
assumption criteria for proportional hazard model.
Conclusion: Optimal dose steroid as per defined ‘optimum’ (<24 hours and doses tailored
to P/F at presentation) criteria can offer protective effect from mortality which persists after
adjusting for age. This protective effect was not found to be negatively influenced by
the risk of infection.
