Effect of High vs Low Dose Corticosteroids on COVID-19 Mortality, Outcomes

Doctor of Latino ethnicity aged 25-35 years are helping patients who are in hospital beds in times of the COVID-19 pandemic
Is the mortality rate in patients with COVID-19 affected by use of high vs low dose corticosteroids — and how does dosage level affect ICU admission and intubation rates?

High dose vs low dose corticosteroids were equally efficacious in reducing the mortality rate among patients with COVID-19, according to meta-analysis and review findings published recently in the Journal of Cardiothoracic and Vascular Anesthesia.

Depending on severity, severe manifestation of COVID-19 associated with pro-inflammatory cytokines, can require mechanical ventilator support, intensive care unit (ICU) admission, long duration of hospital stay, and a high mortality rate. Anti-inflammatory corticosteroid treatment is common for COVID-19 patients as per World Health Organization and the National Institute of Health guidelines for patients with severe COVID-19 or those needing mechanical ventilation or extracorporeal membrane oxygenation. Recent studies have shown conflicting results comparing high dose vs low dose corticosteroids. Researchers sought to evaluate the effect of treatment with high vs low dose corticosteroids on mortality in patients with COVID-19.

For the current analysis, researchers conducted a systematic review through MEDLINE, EMBASE, and CENTRAL databases, which yielded 3 randomized controlled trials, 1 quasi experimental study, and 8 observational studies that included 2759 adult patients (>17 years of age) who were SARS-CoV-2 PCR positive.

The investigators found no significant difference when comparing mortality rates of high vs low dose corticosteroid treatment (n=2632; OR: 1.07 [95% CI, 0.67-1.72]; P =.77, I2=76%; trial sequential analysis=inconclusive). They also found no significant difference in ICU admission rate, duration of hospital stay, duration of mechanical ventilation, infection rate, incidence of hyperglycemia, or respiratory support.

Study limitations cited by the investigators included variations in dosage and types of corticosteroids across the analyzed studies. Additionally, adverse events were not well documented and there was a lack of long-term follow-up.

Researchers concluded that high dose corticosteroid treatment of patients with COVID-19 did not reduce mortality. However, they added that their finding also showed that “high dose corticosteroids do not pose higher risk of hyperglycemia and infection rate for COVID-19 patients.” Notably, the analysis did not shed light on the safety of corticosteroids in COVID-19. The investigators suggested that large-scale randomized clinical trials for comparison of high dose vs low dose corticosteroids in COVID-19 patients were needed.


Tan RSJ, Ng KT, Chau EX, Atan R, Yunos NM, Hasan MS. High dose vs low dose corticosteroids in COVID-19 patients: A systematic review and meta-analysis. J Cardiothorac Vasc Anesth. Published May 13, 2022. doi:10.1053/j.jvca.2022.05.011