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Effect of High and Low-to-Moderate Dose Corticosteroid Therapy Among Hypoxic COVID-19 Patients at Various Time Intervals: A Multi-Centric Retrospective Cohort Study

42 Pages Posted: 27 Apr 2022

See all articles by Arpit Kumar Saha

Arpit Kumar Saha

Rampurhat Government Medical College and Hospitals - Department of Clinical Microbiology

Suvajit Das

affiliation not provided to SSRN

Daliya Biswas

affiliation not provided to SSRN

Baijaeek Sain

affiliation not provided to SSRN

Mrinmoy Mitra

affiliation not provided to SSRN

Ritam Chakraborty

affiliation not provided to SSRN

Sushmita Basu

affiliation not provided to SSRN

Shelley Shamim

affiliation not provided to SSRN

Avik Mukherjee

affiliation not provided to SSRN

Debajyoti Ghosh

affiliation not provided to SSRN

Sujash Biswas

affiliation not provided to SSRN

Simit Kumar

affiliation not provided to SSRN

D.N Gowsami

affiliation not provided to SSRN

S.K. Todi

affiliation not provided to SSRN

More...

Abstract

Background: The ideal dosage, timing, and duration of corticosteroid therapy in covid-19 patients has not yet been determined, and it continues to remain a grey territory.

Methods: A multi-centric retrospective cohort study was conducted among hypoxic COVID-19 patients divided into three groups based on the timing and initiation of corticosteroids concerning onset of symptoms- Group A(on or before day-6), Group B (day 7-9) and Group C (on or after day 10) with further subdivision into high dose and low-to-moderate dose steroid recipients. To estimate the primary outcome(mortality benefit), survival analysis was done using the Cox proportional-hazard model with a propensity score-based method. The secondary outcome was assessed by Kruskal-Wallis test and post-hoc Dunn test for any difference in predefined exposure variables.

Findings: A total of 505 patients were included. Cox regression showed a higher risk of hospital death in high doses of corticosteroid recipients in both Group-A[HR=5·036, 95% CI 2·461-10·302, p-value <0·0001, N=114] and Group-B[HR=3·375, CI 1·91-5·94, p-value<0·0001, N=251]. The mortality rate in Group C was the lowest, 13·47%(N=141), and no significant statistical difference was found(P-value= > 0·05) between the two groups of steroid recipients. Kruskal-Wallis and posthoc Dunn testing among pre-defined exposure variables showed statistical significance for the N/L ratio.

Interpretation: High dose of corticosteroid initiated early in the course of the disease would increase the overall mortality compared to a low-moderate dose. N/L ratio, a marker of the individual immune response, could be a significant predictor for determining the appropriate dosage of corticosteroid therapy.

Funding: Self funded

Declaration of Interest: This study is a non sponsored investigator-initiated academic study; all the researchers declare no conflict of interest

Ethical Approval: Permission was duly obtained from the Institutional Ethics Committees of the two institutes.

Suggested Citation

Saha, Arpit Kumar and Das, Suvajit and Biswas, Daliya and Sain, Baijaeek and Mitra, Mrinmoy and Chakraborty, Ritam and Basu, Sushmita and Shamim, Shelley and Mukherjee, Avik and Ghosh, Debajyoti and Biswas, Sujash and Kumar, Simit and Gowsami, D.N and Todi, S.K., Effect of High and Low-to-Moderate Dose Corticosteroid Therapy Among Hypoxic COVID-19 Patients at Various Time Intervals: A Multi-Centric Retrospective Cohort Study (4/25/2022). Available at SSRN: https://ssrn.com/abstract=4095318 or http://dx.doi.org/10.2139/ssrn.4095318

Arpit Kumar Saha (Contact Author)

Rampurhat Government Medical College and Hospitals - Department of Clinical Microbiology ( email )

India

Suvajit Das

affiliation not provided to SSRN

Daliya Biswas

affiliation not provided to SSRN

Baijaeek Sain

affiliation not provided to SSRN

Mrinmoy Mitra

affiliation not provided to SSRN

Ritam Chakraborty

affiliation not provided to SSRN

Sushmita Basu

affiliation not provided to SSRN

Shelley Shamim

affiliation not provided to SSRN

Avik Mukherjee

affiliation not provided to SSRN

Debajyoti Ghosh

affiliation not provided to SSRN

Sujash Biswas

affiliation not provided to SSRN

Simit Kumar

affiliation not provided to SSRN

D.N Gowsami

affiliation not provided to SSRN

S.K. Todi

affiliation not provided to SSRN