High dose steroids Linked to Increased Covid-19 Mortality in Non-Oxygenated Hospitalized Patients: NEJM

Italy: A new study published in NEJM Evidence has found that the use of glucocorticoids in hospitalized patients with COVID-19 who are not receiving oxygen may increase their risk of mortality.

Glucocorticoids have been shown to reduce mortality in severe and critical cases of COVID-19, but this study suggests that they may be harmful in patients who are not on oxygen therapy.

Researchers conducted a search of various databases (Embase, BioMed Central, medRxiv, bioRxiv, PubMed, and the Cochrane Central Register of Controlled Trials) for randomized trials or matched studies that compared glucocorticoid treatment to standard therapy or placebo in adult COVID-19 patients who were not receiving oxygen.

The study ultimately included five randomized trials and one propensity-matched study, involving a total of 6,634 hospitalized patients not on oxygen.

The study concluded with the following clinical findings:

1. 3,704 patients received glucocorticoids and 2,930 patients received standard treatment.

2. The mortality rate was significantly higher in patients treated with glucocorticoids.

3. The number needed to harm was 27, meaning for every 27 patients treated with glucocorticoids who were not receiving oxygen, one additional patient died.

The study has some limitations, including the fact that it only included hospitalized patients who were not on oxygen therapy and the possibility of confounding variables in the included studies.

“The findings suggest that the use of glucocorticoids in non-critical COVID-19 cases may not be beneficial and could potentially be harmful. It is important for healthcare providers to weigh the risks and benefits of glucocorticoid treatment for COVID-19 patients who are not on oxygen therapy. The results provide valuable insight into the use of glucocorticoids in COVID-19 treatment and highlight the need for further research on this topic.” said the researchers of the study.

Reference:

Covello R., Pasin L., Fresilli S., et al.; Meta-Analysis of Glucocorticoids for COVID-19 Patients Not Receiving Oxygen; NEJM Evidence, 2023.04.18; DOI: 10.1056/EVIDoa2200283