While our understanding of why COVID-19 affects different individuals so dramatically remains vexing, clinicians at Montefiore Medical Center in the Bronx, New York, put together an observational study to determine whether early treatment with glucocorticoids is associated with reduced mortality or the need for mechanical ventilation. The study was based on their observation that some colleagues were prescribing steroids to COVID-19 patients while others were not.
To ensure treatment preceded outcome measurement, they included only those patients treated with glucocorticoids within the first 48 hours of admission and compared them with patients who did not receive glucocorticoids. The 2 groups were similar with one exception: glucocorticoid-treated patients were more likely to have chronic obstructive pulmonary disease (COPD), asthma, rheumatoid arthritis, or lupus, or to have received glucocorticoids in the year prior to admission.
In this study, treatment with glucocorticoids was not associated with mortality or the need for mechanical ventilation. However, subgroup analyses suggest that treatment group patients with elevated C-reactive protein (CRP) levels may benefit from glucocorticoid treatment, whereas those with lower levels of CRP may be harmed.
Using 3 CRP values, the authors found the following odds ratios (OR) and adjusted OR (aOR):
- CRP range 0-9.9 mg/dL (n = 807): OR 2.64 (95% Confidence Interval [CI], 1.39-5.03), aOR 3.14 (CI, 1.52-6.50).
- CRP range 10 mg/dL-19.9 mg/dL (n= 442): OR 1.03 (CI0.47-2.23), aOR of 1.05 (0.46-2.39).
- CRP range, ≥20 mg/dL (n = 198): OR 0.23 (0.08-0.70), aOR 0.20 (0.06-0.67).
The CRP test is inexpensive and widely available, and the authors suggest it may identify a patient subpopulation that may benefit from receiving steroids at the right time in their battle with COVID-19.
Source: Keller MJ, Kitsis EA, Arora S, et al. Effect of Systemic Glucocorticoids on Mortality or Mechanical Ventilation in Patients With COVID-19. J. Hosp. Med 2020;8;489-493.