Steroid treatment benefits some, may harm others with COVID-19

A blood test to assess C-reactive protein levels in patients with COVID-19 may help determine who would benefit from treatment with glucocorticoid and who would not, according to a study published in the Journal of Hospital Medicine.

The study follows preliminary results from the U.K. RECOVERY trial, which showed that in patients with COVID-19, treatment with dexamethasone reduced mortality by about a third in those on ventilators and by about one-fifth in those receiving oxygen.

“Our study is consistent with the promising findings from Britain, but for the first time, we are able to demonstrate that people can see the same life-saving benefits with steroid formulations other than dexamethasone,” Marla Keller, MD, vice chair for research in the department of medicine at Albert Einstein College of Medicine and Montefiore Health Systems in New York, said in a press release. “We also found that a common blood test may identify the best candidates for steroid treatment.”

Keller and colleagues evaluated 2,998 patients admitted to the Montefiore Medical Center in New York from March 11 through April 13. The researchers compared outcomes among patients hospitalized with COVID-19 who received glucocorticoid treatment within the first 48 hours of admission with those who never received glucocorticoid treatment.

After exclusions, 140 patients with COVID-19 who were treated with glucocorticoids and 1,666 who did not receive glucocorticoids were included in the study.

The researchers found that overall, the use of glucocorticoids within 48 hours of admission was not associated with in-hospital mortality or mechanical ventilation.

When examining subgroups by levels of C-reactive protein (CRP), Keller and colleagues identified significant differences between subgroups.

They found that in patients with an initial CRP of 20 mg/dL or greater, early glucocorticoid use was associated with a significantly reduced risk for mortality or mechanical ventilation in both unadjusted analyses (OR = 0.23; 95% CI, 0.08-0.7) and adjusted analyses (aOR = 0.2; 95% CI, 0.06-0.67).

However, in patients with CRP levels less than 10 mg/dL, glucocorticoid treatment was associated with a significant risk for mortality or mechanical ventilation in both unadjusted analyses (OR = 2.64; 95% CI, 1.39-5.03) and adjusted analyses (aOR = 3.14; 95% CI, 1.52-6.50).

“Our findings suggest that steroid therapy should be reserved for people with high inflammation, as indicated by markedly elevated CRP levels,” William Southern, MD, MS, professor of medicine and chief of the division of hospital medicine at Albert Einstein College of Medicine and Montefiore Health Systems, said in a press release. “It's a different story for people who do not have significant inflammation; for them, any benefit is outweighed by the risks from using steroids.”