Steroids improve survival rate of critically ill COVID-19 patients

Patients that were treated with a fixed dose of the steroid hydrocortisone in intensive care had a better chance of recovery, according to a study at 88 UK hospitals. Another hormone, dexamethasone, was found to improve recovery time.

The effort was led by Professor Anthony Gordon from Imperial College London, but it was a major research effort involving multiple doctors from hospitals across the country. The published results actually summarize several trials and studies carried out by researchers in Britain, Brazil, Canada, China, France, Spain, and the United States, all of which paint a consistent message.

In the hydrocortisone study, 403 COVID-19 patients who required respiratory or cardiovascular support (such as mechanical ventilation or blood pressure drugs) were split into three groups: one group was treated with a dose of hydrocortisone four times a day for a week, another got no hydrocortisone, and the third was treated only if their blood pressure dropped. Although it’s a small sample size, the patients included mixed ethnicities and nationalities, which makes the results more robust.

In both hydrocortisone groups, the steroid produced substantial improvements. A fixed dose of hydrocortisone led to a 93% chance of a better outcome (greater survival rate and less need for organ support) than no hydrocortisone. In the group that only received the steroid when blood pressure was low, the chance of a better outcome was 80%. Overall, the steroid increased survival rate from 60 to 68%, a significant improvement.

“This is equivalent to around 68% of (the sickest COVID-19) patients surviving after treatment with corticosteroids, compared to around 60% surviving in the absence of corticosteroids,” the researchers said in a statement.

A different study (the RECOVERY trial) investigated another steroid, dexamethasone. Dexamethasone was hailed as a major find in the fight against COVID-19, but published results have been scarce. These newly-published results back up dexamethasone as a way to improve recovery rates and decrease recovery time. In fact, when the dexamethasone results were first announced a couple of months ago, it was deemed so successful that the hydrocortisone study researchers actually had difficulty finding participants.

The findings are published in JAMA alongside further clinical trials evidencing the benefits of a range of steroids (all safe, cheap, and readily available), especially as a treatment for severely ill patients.

The study results are owed to an international effort. Professor Gordon, from the Department of Surgery and Cancer at Imperial, added:

“This has been an incredible international effort. We were all aware of the other studies and were happy to share our raw data before it was published. Only by collaborating were we going to make real advances and make them fast.”

The study is also a testament to how much science can progress in a span of only a few months — it’s remarkable that researchers have already discovered working treatments.

The World Health Organization has issued a “strong recommendation” for steroid treatment in critically ill patients.