Abstract

Objective: To assess the outcomes of corticosteroid usage in Coronavirus disease-2019 (COVID-19) patients treated in the intensive care unit (ICU) and determine factors associated with secondary infection and mortality.

Method: This retrospective analysis involved data from patients admitted to the ICU for COVID-19 treatment between April 1, 2020, and December 31, 2021. The medical records of 114 patients who received corticosteroids and the records of 94 patients who did not, were comprehensively reviewed, and information about demographic characteristics, clinical features, and laboratory results was recorded.

Results: The 28-day mortality rate was 52.9% (n=110), the overall mortality was 61.5% (n=128), and secondary infection occurred in 52.9% (n=110) of COVID-19 ICU patients. Steroid users had longer ICU stays (p=0.001), longer intubation periods (p<0.001), a higher need for positive inotropic therapy (p<0.001), and higher APACHE II scores (p=0.014). Overall mortality was higher in steroid recipients (p=0.001), while 28-day mortality was similar (p=0.061). The frequency of secondary infections in COVID-19 ICU patients was significantly higher in the steroid group (p=0.003). Multivariable logistic regression analysis indicated that extended ICU stays [odds ratio (OR): 1.174] and prolonged intubation (OR: 1.317) were independently associated with secondary infections. Similarly, older age (OR: 1.079), need for renal replacement therapy (OR: 7.600), need for positive inotropic therapy (OR: 25.627), and high SOFA score (OR: 1.528) were independently associated with mortality.

Conclusion: According to the findings of the study, although corticosteroid use in severe COVID-19 cases does not appear to increase the risk of secondary infections or mortality, the decision to use corticosteroids should be made with careful consideration of the patient’s clinical condition. Additionally, more comprehensive and in-depth studies on the use of corticosteroids in COVID-19 patients are needed.