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.