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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
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: Suggested Citation