Are high dose steroids are preferable than low dose steroids in COVID 19 pneumonia?

Abstract

Background: In COVID 19 there is systemic inflammatory response that can lead to lung injury and multisystem organ dysfunction. It has been proposed that the potent anti-inflammatory effects of corticosteroids might prevent or mitigate these deleterious effects. Conversly at the other end of the dose range high levels of corticosteroids are immunosuppressive and can increase risk of fatal infection including sepsis. Giving optimal level of corticosteroids at the right time is vital to control infections and restore homeostasis. Aim: The aim of the study is to compare benefits and side effects of high dose corticosteroids and low dose corticosteroids in treatment of covid 19 pneumonia. Materials and Methods: This study is retrospective, observational study of 80 patients diagnosed with covid 19 pneumonia. They were divided into two groups, one group of patients received low dose of steroids (0.5-1mg/kg/day for 7-10days) and other group of patients received high dose of steroids(>250mg/day for 7-10days).In these two groups of patients we compared duration of hospital stay, duration of oxygen support, mortality rate of the patients. These group of patients are followed up for development of side effects of corticosteroids, here we look into three side effects-recurrent infections, poorly controlled diabetes and skin manifestations. Data was analysed. Results: Out of 80 patients (40 in high dose group and 40 in low dose group) mean duration of hospital stay and mean number of days of oxygen support were more in high dose group compared to low dose group. However, the difference was not found to be statistically significant (P value >0.05). In low dose group 22.5% died as compared to 40% in high dose group. However, on performing chi square test, this difference was not found to be statistically significant (P value >0.05). In low dose group 3.2% had complications as compared to 25% in high dose group. On performing chi square test, this difference was found to be statistically significant (P value