Is the Effect of Pulse Corticosteroid Different From the Lower Dose on Mortality in Hospitalized Patients with COVID-19 Pneumonia?

Introduction: The novel coronavirus disease-2019 (COVID-19) is a disease with high mortality and morbidity. The aim of this study was to investigate the prognostic effect of pulse corticosteroid therapy in patients with COVID-19 pneumonia. Materials and Methods: Patients who were hospitalized due to COVID-19 pneumonia between June 2020 and December 2020 were included in the study. All data were retrospectively obtained. Age, gender, smoking history, presence of chronic disease, and laboratory parameters of the patients were recorded. Information about radiological involvement, respiratory failure, corticosteroid treatment/ pulse corticosteroid treatment status, transfer to the intensive care unit, and mortality was obtained. Results: Two-hundred and sixty-one patients were included in the study. There were 231 patients in the lower dose and 30 patients in the pulse dose corticosteroid group. The median age of the patients was similar in both pulse corticosteroid and lower dose corticosteroid groups [respectively; median 59 years (IQR= 19 years) vs. 60 years (IQR= 20 years), p= 0.66]. CRP levels were significantly higher and blood lymphocyte count was significantly lower in the pulse dose corticosteroid group (p= 0.01, p= 0.02). Eight patients (3.5%) died in the lower dose corticosteroid group and five patients (16.7%) died in the pulse dose corticosteroid group; the difference was statistically significant (p= 0.01). Propensity score matching according to age, sex, respiratory failure, CRP, ferritin, and LDH levels, revealed no difference in mortality between pulse dose or lower dose corticosteroid therapy (p= 0.71). Conclusion: In the context of COVID-19 treatment, the administration of pulse-dose corticosteroid therapy does not appear to confer a beneficial effect on mortality when compared to lower-dose therapy.