Glucocorticoids improve 30-day survival probability in critical coronavirus disease 2019 patients

Abstract

Background: The optimal approach to manage Coronavirus Disease 2019 (COVID-19) patient is still uncertain, especially for critical ill patients, high mortality has been observed since the outbreak of the crisis. Glucocorticoid use has been in debate for treating COVID-19-infected patient. Methods: Twenty-nine critically ill patients with COVID-19 in this report are defined as patients are intubated and admitted to intensive care unit (ICU). Chart review was conducted on those patients, their demographic characteristics, baseline comorbidities, hospital course, clinical management, and laboratory/imagine reports were summarized. Thirty-day survival probability after ICU admission was analyzed for comparing the steroid group and nonsteroid group. Survival curve and analysis were performed by Kaplan-Meier survival analysis. P value less than 0.05 is defined as significant different. Results: Among the 29 critical COVID-19 cases, 12 are survived beyond day 30 of ICU admission, 9 of the 12 are successfully extubated and discharged home, 3 remained on ventilator support in ICU after 30 days. In the 12 survived patients, 10 (83%) received glucocorticoid treatment, whereas in the 17 patients who died, only 8 (44%) were treated with steroid. The baseline characteristics between the steroid and nonsteroid group are similar. The 30-day survival rate is lower in the steroid group comparing to the nonsteroid group (P = 0.0405). Conclusions: Proper use of glucocorticoids offers considerable mortality benefit to the outcome of critical ill COVID-19 patient. This observational descriptive study might be helpful to other similar small community hospital facing a surge of COVID-19 patients, when other clinical trials or supports are hardly available.