• Michele Bartoletti, Lorenzo Marconi, Luigia Scudeller, Livia Pancaldi, Sara Tedeschi, Maddalena Giannella, Matteo Rinaldi, Linda Bussini, Ilaria Valentini, Anna Filomena Ferravante, Antonella Potalivo, Elisa Marchionni, Giacomo Fornaro, Renato Pascale, Zeno Pasquini, Massimo Puoti, Marco Merli, Francesco Barchiesi, Francesca Volpato, Arianna Rubin, Annalisa Saracino, Tommaso Tonetti, Paolo Gaibani, Vito Marco Ranieri, Pierluigi Viale, Francesco Cristini, and PREDICO Study Group.
• Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy. Electronic address: m.bartoletti@unibo.it.
• Clin. Microbiol. Infect. 2021 Jan 1; 27 (1): 105-111.

ObjectiveTo assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19).MethodsA multicentre observational study was performed from 22 February through 30 June 2020. We included consecutive adult patients with severe COVID-19, defined as respiratory rate ≥30 breath per minute, oxygen saturation ≤93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ≤300 mm Hg. We excluded patients being treated with other immunomodulant drugs, receiving low-dose corticosteroids and receiving corticosteroids 72 hours after admission. The primary endpoint was 30-day mortality from hospital admission. The main exposure variable was corticosteroid therapy at a dose of ≥0.5 mg/kg of prednisone equivalents. It was introduced as binomial covariate in a logistic regression model for the primary endpoint and inverse probability of treatment weighting using the propensity score.ResultsOf 1717 patients with COVID-19 evaluated, 513 were included in the study, and of these, 170 (33%) were treated with corticosteroids. During hospitalization, 166 patients (34%) met the criteria of the primary outcome (60/170, 35% in the corticosteroid group and 106/343, 31% in the noncorticosteroid group). At multivariable analysis corticosteroid treatment was not associated with lower 30-day mortality rate (adjusted odds ratio, 0.59; 95% confidence interval (CI), 0.20-1.74; p 0.33). After inverse probability of treatment weighting, corticosteroids were not associated with lower 30-day mortality (average treatment effect, 0.05; 95% CI, -0.02 to 0.09; p 0.12). However, subgroup analysis revealed that in patients with PO2/FiO2 < 200 mm Hg at admission (135 patients, 52 (38%) treated with corticosteroids), corticosteroid treatment was associated with a lower risk of 30-day mortality (23/52, 44% vs. 45/83, 54%; adjusted odds ratio, 0.20; 95% CI, 0.04-0.90; p 0.036).ConclusionsThe effect of corticosteroid treatment on mortality might be limited to critically ill COVID-19 patients.Copyright © 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

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