key: cord-0861308-xw2pk1k3
authors: Longobardo, Alessia; Snow, Tim; Montanari, Cecilia; Shulman, Robert; Singer, Mervyn; Arulkumaran, Nishkantha
title: COVID-19 and non-COVID ARDS patients demonstrate a distinct response to low dose steroids- A retrospective observational study
date: 2020-11-21
journal: J Crit Care
DOI: 10.1016/j.jcrc.2020.11.012
sha: d99611eb3075443d956112da3a36abf33158f699
doc_id: 861308
cord_uid: xw2pk1k3

Patients with COVID-19 ARDS have distinct physiological and immunological phenotypes compared to patients with non-COVID ARDS. Patients with COVID-19 ARDS (n = 32) had a significant improvement in PaO(2): FiO(2) ratio (p = 0.046) following low-dose steroid treatment, unlike patients with non-COVID ARDS (n = 16) (p = 0.529). Patients with COVID-19 ARDS had a greater fall in CRP compared to patients with non-COVID ARDS, albeit not statistically significant (p = 0.07). Our novel findings highlight differences in the underlying physiological and immunological phenotypes between COVID-19 and non-COVID ARDS, with implications for future ARDS studies.

Patients with COVID-19 ARDS have distinct physiological [1, 2] and immunological [3, 4] phenotypes compared to patients with non-COVID ARDS. We hypothesised that differences in immunological and physiological phenotypes between patients with COVID-19 and non-COVID ARDS are associated with differences in changes to inflammation and PaO 2 : FiO 2 ratio in response to steroid treatment.

We conducted a single-centre retrospective case-control study of COVID-19 patients with ARDS treated with low-dose systemic steroids at University College London Hospital between 1st March and 30th June 2020.

During the COVID-19 pandemic, methylprednisolone was prescribed for ARDS with persistent or worsening hypoxaemia, hydrocortisone was prescribed for septic shock. As the period of data collection preceded the results of the RECOVERY study, dexamethasone was not routinely prescribed for patients with COVID-19.

Data on consecutive patients with non-COVID ARDS receiving steroids between January 2018 to March 2020 were used as comparison.

Data were extracted from electronic healthcare records on patient demographics, corticosteroid type and dose, and sequential C-reactive protein, neutrophil, and temperature. Where patients received more than one course of steroid, only the first course of steroid was considered. We included patients receiving either methylprednisolone 1-2 mg/kg daily or hydrocortisone 50-100mg four times daily. As the half-life of CRP is 19 hours [5] , we collected data on CRP change 3 days following steroid administration. Ten patients in the non-COVID group and 12 patients in the COVID group did not survive for at least 3 days following steroid administration and were therefore excluded. Haemato-oncology patients (n=18) who had received recent chemotherapy were excluded as the inflammatory response could be confounded by chemotherapy. 

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