Effects of early corticosteroid use in patients with severe coronavirus disease 2019

초록

BackgroundCoronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents for this disease. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes.MethodsThis was a retrospective cohort study including patients with severe COVID-19 who received corticosteroid treatment from March 2 to June 30, 2020 in seven tertiary hospitals in South Korea. We analyzed the patient demographics, characteristics, and clinical outcomes according to the timing of steroid use. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids.ResultsOf the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO2/FiO(2) ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08days and the treatment duration was 14days in the early use group, while those in the late use group were 12.80days and 18.50days, respectively. The PaO2/FiO(2) ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4days vs. 60.0days, P=0.030), time from diagnosis to discharge (27.8days vs. 57.4days, P=0.024), and hospital stay (26.0days vs. 53.9days, P=0.033) were shortened.ConclusionsAmong patients with severe COVID-19, early use of corticosteroids showed favorable clinical outcomes which were related to a reduction in the length of hospital stay.

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