Short-Term Corticosteroids in SARS-CoV2 Patients: Hospitalists’ Perspective

  1. Vijairam Selvaraj
  2. Kwame Dapaah-Afriyie
  3. Arkadiy Finn
  4. Timothy Flanigan

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Abstract

Background

Dexamethasone, a synthetic glucocorticoid, has anti-inflammatory and immunosuppressive properties. There is a hyperinflammatory response involved in the clinical course of patients with pneumonia due to SARS-CoV2. To date, there has been no definite therapy for COVID-19. We reviewed the charts of SARS-CoV2 patients with pneumonia and moderate to severely elevated CRP and worsening hypoxemia who were treated with early, short-term dexamethasone.

Methods

We describe a series of 21 patients who tested positive for SARS-CoV2 and were admitted to The Miriam Hospital in Providence and were treated with a short course of dexamethasone, either alone or in addition to current investigative therapies.

Results

CRP levels decreased significantly following the start of dexamethasone from mean initial levels of 129.52 to 40.73 mg/L at time of discharge. 71% percent of the patients were discharged home with a mean length of stay of 7.8 days. None of the patients had escalation of care, leading to mechanical ventilation. Two patients were transferred to inpatient hospice facilities on account of persistent hypoxemia, in line with their documented goals of care.

Conclusions

A short course of systemic corticosteroids among inpatients with SARS-CoV2 with hypoxic respiratory failure was well tolerated, and most patients had improved outcomes. This limited case series may not offer concrete evidence towards the benefit of corticosteroids in COVID-19. However, patients’ positive response to short-term corticosteroids demonstrates that they may help blunt the severity of inflammation and prevent a severe hyperinflammatory phase, in turn reducing the length of stay, ICU admissions, and healthcare costs.

Summary

In this series, we demonstrate that timely, short-term use of systemic corticosteroids among hospitalized patients with hypoxic respiratory failure due to SARS-CoV2 was well tolerated with good outcomes. The outcomes were reflected by reductions in inpatient mortality, CRP levels, requirement for mechanical ventilation and escalation of care.

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  1. Version published to 10.1101/2020.06.19.20109173v2 on medRxiv
  2. ScreenIT

    SciScore for 10.1101/2020.06.19.20109173: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The Institutional Review Board of the Hospital approved the study.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has many limitations. Being a case series, there is only a small number of patients that were followed. The study design has inherent biases along with patient selection. In addition, it is difficult to delineate the role played by other therapies administered concurrently along with corticosteroids. There is however, evidence that comparable patients who were enrolled in other therapies but did not receive the short course of dexamethasone ended up with a longer length of hospital stay.21 In conclusion, timely initiation of short course dexamethasone, a low cost, and relatively low-risk intervention may help prevent the progression of hypoxic respiratory failure in moderate to severely ill patients and help accelerate recovery. Further large-scale studies are urgently needed to study the role of early use of corticosteroids in SARS-CoV2 positive patients, especially those at high risk of clinical deterioration. Additional studies about the immune response associated with SARS-CoV2 infections, the use of velocity of CRP in disease monitoring, and the utility of dexamethasone with or without other therapeutic options are needed.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04445506CompletedShort Term Corticosteroids in SARS-CoV2 Patients

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.06.19.20109173v1 on medRxiv