Does high-dose corticosteroid treatment increase COVID-19 mortality in intensive care units?

INTRODUCTION: We aimed to investigate the association between different corticosteroid treatment regimens and clinical status, complications, requirements for mechanical ventilation, and intensive care unit (ICU) mortality in individuals diagnosed with COVID-19.
METHODS: This is a cross-sectional, descriptive, retrospective study. Patients admitted to the ICU for COVID-19 and treated with low-medium-dose corticosteroid therapy (methylprednisolone at a dose of 0.5-1 mg/kg for 7-10 days) were compared with patients treated with high-dose pulse corticosteroid therapy (methylprednisolone at varying doses of 250, 500 or 1000 mg for 3-7 days) in addition to standard therapy because of increased pulmonary infiltrate and elevated inflammatory markers during clinical monitoring. All demographic and clinical data, including age, sex, clinical course, laboratory findings, discharge status, 28-day mortality, intubation status, APACHE II score, Charlson Comorbidity Index, and SOFA score, were recorded.
RESULTS: Corticosteroid treatment was administered to 689 (88.3%) of 780 COVID-19 ICU patients between April 2020 and October 2021. The overall mortality rate was 45.1% (n=352). When the mortality rates of patients were compared according to the dose of corticosteroids used, the mortality rate in the low-medium-dose group (40%) was statistically significantly lower than in the high-dose group (76%). In addition, a significant deterioration in laboratory and clinical parameters was observed in the high-dose corticosteroid group.
DISCUSSION AND CONCLUSION: High mortality, corticosteroid adverse effects, and complications were found to increase significantly when high doses of corticosteroids were used. Corticosteroid therapy should be used cautiously according to the patient's clinical condition, stage of disease, comorbidities, and systemic or organ reserves.