Efficacy of Low-dose vs High-dose Pulse Therapy of Methylprednisolone on Selected Clinical Outcomes among Moderate to Severe COVID-19 Patients: A Retrospective Observational Study from Intensive Care Units

Introduction:Corticosteroids have been proposed as a promising treatment to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced inflammatory states and to reduce mortality.Aims and objectives: To compare the efficacy of two different doses of methylprednisolone in moderate to severe COVID-19 patients with respect to mortality, the need for mechanical ventilation (MV), and the risk of developing severe acute respiratory distress syndrome (ARDS).Materials and methods: A retrospective observational study was conducted on adult COVID-19 patients admitted to a tertiary care hospital.Electronic medical records from February 2020 to February 2022 were reviewed, and data regarding 300 eligible patients were extracted.Demographic, clinical, and radiological information were recorded, including comorbidities, respiratory variables, and details of treatment.Patients were categorized into two groups based on received dosages of steroids: High-dose (HD) of methylprednisolone (120 mg/day) vs low-dose (LD) (40 mg/day).Results: Low-dose was received by 215 patients, whereas 85 patients received HD.Patients in the HD group were slightly younger (61.24 years) as compared to LD (64.27 years) patients.The most common comorbidity was diabetes mellitus, with prevalences of 55.8 and 57.6%, followed by hypertension (45.1 and 42.4%) in the LD and HD groups, respectively.More number of patients in the HD group received MV in comparison to the LD group (95.3 vs 86%) (p = 0.02).However, days spent on MV were comparable in both groups (p = 0.29).Mortality was higher in the HD group ( 35.3 vs 26.5%).Approximately half of the patients (50.6%) in the HD group developed severe ARDS in comparison to the LD group (27.9%) (p = 0.001).During the hospital stay, 64.7% of patients in the HD group required oxygenation through high-flow nasal cannula (HFNC) in comparison to 46% in the LD group (p = 0.004).Conclusion: Low-dose corticosteroids may improve clinical outcomes in COVID-19 patients in comparison to high-dose.