4. DISCUSSION
The emerging role of steroids in the management of moderately to severely ill COVID-19 patients was the motivation for our study. This retrospective study was conducted to assess the role of steroids in the management of patients with moderate or severe COVID-19 infection. The outcome of patients, whether recovery from or death due to COVID-19 infection, who received steroids was compared with the patients who did not receive steroids as part of their treatment for COVID-19 infection. The other main parameter that was compared between the two groups was their length of hospital stay during the course of their illness, which may have been affected by the baseline comorbidities they might have. The majority of the patients in the steroids group (96%) recovered uneventfully and were discharged from the hospital. The mortality rate in this group was 4% compared to that of 8% in the non-steroids group. Although the mortality rate was higher in the non-steroids group, it was statistically non-significant. Our findings are in line with a meta-analysis published in May 2020, which showed that corticosteroids did not significantly reduce the risk of death in COVID-19 patients.9 The mean length of hospital stay in our study was also less in the steroids group than that in the non-steroids group; however, it was non-significant. This is contrary to the results of the meta-analysis which showed that the steroids use increased the length of hospital stay.9 Severity of the disease among the two groups as well as the maximum oxygen requirement was found to be similar, which may indicate that the steroids had a minimal effect on the severity of the COVID-19 infection in our study.
Regarding the baseline comorbidities, lymphopenia was higher in the steroids group whereas the incidences of diabetes mellitus and ischemic heart disease were lower in this group. Whether this difference in the baseline comorbidities had any impact on our findings, we could not perform the regression analysis due to the limited sample size in order to address this issue. Additionally, since this was a retrospective analysis of the data of COVID-19 patients, we were unable to compare the other characteristics such as age and disease severity between the two groups. These limitations warrant larger multicenter randomized clinical trials with adequate sample size to compare the safety and efficacy of steroids in patients with moderate and severe COVID-19 infection and the factors affecting them. Moreover, since the steroids, as compared to antivirals, are inexpensive and readily available in developing countries, findings of these trials conducted in developing countries can provide enormous benefits and save a larger number of patients from complications with an economic impact on the limited resources.