Does outpatient steroid therapy prevent mortality in COVID-19 hospitalized patients ?

Background Standardized consensus for therapeutical protocols in outpatients with COVID-19 is lacking. Steroids have proved to be beneficial in the hospital setting when pneumonia and respiratory failure are present. However, steroids are prescribed often outside the hospital by general practitioners. Methods We conducted a retrospective observational study on patients hospitalized for COVID-19 pneumonia from September 2020 to June 2021 at our Infectious Diseases Unit. We analyzed steroid treatment received by these patients before the hospital admission. The following variables were collected and analyzed: age, gender, body mass index, hypertension, chronic obstructive pulmonary disease (COPD), diabetes mellitus and immunosuppression. 30-day survival rate was evaluated as primary outcome. Results A total of 794 patients (533 males) were included in the study. 201 (25%) patients received steroids before hospital admission while 593 (75%) patients did not (p=0.02). Other patients characteristics are shown in Figure 1.The mean time from disease onset to the beginning of steroid treatment was of 5.8 ± 3.2 days. The duration of steroid treatment was of 3.7 ± 1.9 days. The overall steroid dose of prednisone (equivalent dose) was 147 ± 85 mg.At univariate analysis, the 30-day survival probability was 85% in those who received outpatient steroids and 70% in those who did not receive steroids (p=0.002; HR 0.45) (Figure 2). Multivariate analysis demonstrated that age and COPD (p=0.038; OR 0.65) reduced the outcome predictability of steroids but their administration remained statistically significant in improving survival (OR 0.51; p=0.032). The increase in survival in those who received steroids as outpatients is particularly evident in patients with more than 77 years in comparison to those < 67 years (p ≤ 0.001) and those between 67 and 77 years (p=0.001). Conclusions The administration of outpatient steroids after 5 days from the disease onset may protect from the risk of death in those who experience hospitalization. This steroid benefit may increase in the elderly population.