Viral clearance after early corticosteroid treatment in patients with moderate or severe covid-19
Vincenzo Spagnuolo, Monica Guffanti, Laura Galli, Andrea Poli, P. Rovere Querini, Marco Ripa, Massimo Clementi, Paolo Scarpellini, Adriano Lazzarin, Moreno Tresoldi, Lorenzo Dagna, Alberto Zangrillo, Fabio Ciceri, Antonella Castagna, COVID-BioB study group, Andrea Andolina, M Baiardo Redaelli, Elena Baldissera, Giorgia Bigai, Alba Bigoloni, Nicola Boffini, Giorgia Borio, Simona Bossolasco, Elena Bruzzesi, Maria Grazia Calabró, Stefania Calvisi, Corrado Campochiaro, Diana Canetti, Valentina Canti, Jacopo Castellani, Battistina Castiglioni, Giulio Cavalli, Ludovica Cavallo, Massimo Cernuschi, Matteo Chiurlo, Marta Cilla, Elena Cinel, Paola Cinque, Caterina Conte, Valentina Da Prat, Anna Danise, Rebecca De Lorenzo, Giacomo De Luca, Antonio Dell’Acqua, Raffaele Dell’Acqua, Emanuel Della‐Torre, Liviana Della Torre, Gaetano Di Terlizzi, Iulia Dumea, Federica Farolfi, Marica Ferrante, Claudia Frangi, Luca Fumagalli, Gabriele Gallina, Bruno Germinario, Nicola Gianotti, Hamid Hasson, Francesca Lalla, Giovanni Landoni, Marco Lanzillotta, Raffaele Li Voti, Andrea Mastrángelo, Emanuela Messina, Elena Moizo, Marco Montagna, Giacomo Monti, Giulia Morsica, Camilla Muccini, Silvia Nozza, Chiara Oltolini, Maria Paola Pascali, Alessandro Patrizi, Marina Pieri, Dario Prestifilippo, Giuseppe A. Ramirez, Martina Ranzenigo, Jacopo Sapienza, Silvia Sartorelli, F. Seghi, Giuseppe Tambussi, Chiara Tassan Din, Alessandro Tomelleri, Stefano Turi, Caterina Uberti‐Foppa, Concetta Vinci
Abstract
Abstract The aim of this study was to evaluate the impact of early treatment with corticosteroids on SARS-CoV-2 clearance in hospitalized COVID-19 patients. Retrospective analysis on patients admitted to the San Raffaele Hospital (Milan, Italy) with moderate/severe COVID-19 and availability of at least two nasopharyngeal swabs. The primary outcome was the time to nasopharyngeal swab negativization. A multivariable Cox model was fitted to determine factors associated with nasopharyngeal swab negativization. Of 280 patients included, 59 (21.1%) patients were treated with steroids. Differences observed between steroid users and non-users included the proportion of patients with a baseline PaO 2 /FiO 2 ≤ 200 mmHg (45.8% vs 34.4% in steroids and non-steroids users, respectively; p = 0.023) or ≤ 100 mmHg (16.9% vs 12.7%; p = 0.027), and length of hospitalization (20 vs 14 days; p < 0.001). Time to negativization of nasopharyngeal swabs was similar in steroid and non-steroid users (p = 0.985). According to multivariate analysis, SARS-CoV-2 clearance was associated with age ≤ 70 years, a shorter duration of symptoms at admission, a baseline PaO 2 /FiO 2 > 200 mmHg, and a lymphocyte count at admission > 1.0 × 10 9 /L. SARS-CoV-2 clearance was not associated with corticosteroid use. Our study shows that delayed SARS-CoV-2 clearance in moderate/severe COVID-19 is associated with older age and a more severe disease, but not with an early use of corticosteroids.