The patients with high levels of inflammation who received steroids, anti-inflammatory medicines used to treat a range of conditions, were also 75% less likely to require ventilator support to maintain oxygen levels in their lungs.
The study, conducted by the Albert Einstein College of Medicine and the Montefiore Health System, involved 1,806 hospitalized COVID-19 patients, with 140 patients being treated with steroids within 48 hours of admission.
Most of the patients treated with steroids received prednisone. Some, however, received dexamethasone and methylprednisolone.
The patients involved in the study had blood tests done to measure their levels of C-reactive protein (CRP), which the liver produces in response to inflammation. A higher CRP level is associated with a greater amount of inflammation.
"We found that in patients with high levels of inflammation, namely a CRP level greater than 20, steroids were associated with a 75% reduction in the risk of going on mechanical ventilation or dying,” said Dr. Marla Keller, vice chair for research in the Department of Medicine at Einstein and Montefiore and lead author of the study, in a Wednesday news release.
“Critically, we also found that for patients with a lower level of inflammation - CRP levels less than 10 - steroid use was associated with an almost 200% increased risk of going on mechanical ventilation or death,” Keller added.
The study thus found that only COVID-19 patients with high levels of inflammation should be treated with steroids.
"Our findings suggest that steroid therapy should be reserved for people with high inflammation, as indicated by markedly elevated CRP levels," said Dr. William Southern, who was also involved in the study.
"It's a different story for people who do not have significant inflammation: for them, any benefit is outweighed by the risks from using steroids,” Southern added.
The researchers thus concluded that clinicians should test patients’ blood for CRP levels before deciding whether to administer steroid treatment.
Study co-author Shitij Arora also noted that the research involved equal numbers of male and female patients, and the participants were ethnically diverse.
"The demographic diversity of the patients in this study suggests that steroid therapy benefits hospitalized COVID-19 patients affected by significant inflammation regardless of their race or ethnicity," Arora said.
