July 22 (UPI) — Hospitalized COVID-19 patients with high levels of inflammation in their lungs saw a 75% reduction in their risk for death after receiving steroid treatment, a study published Wednesday by the Journal of Hospital Medicine found.
These patients also were 75% less likely to require ventilator support to maintain oxygen levels in their lungs, the researchers said.
Testing patients for levels of inflammation before starting steroid treatment will likely help identify the best candidates for the approach, they said.
“Our findings suggest that steroid therapy should be reserved for people with high inflammation,” study co-author Dr. William Southern said in a statement.
“It’s a different story for people who do not have significant inflammation — for them, any benefit is outweighed by the risks from using steroids,” said Southern, chief of the division of hospital medicine at Montefiore Health System in New York City.
Many who die from severe COVID-19 do so as a result of the body’s intense inflammatory response, which can overwhelm and severely damage the lungs.
For their research, Southern and his colleagues compared patient outcomes among two groups selected from nearly 3,000 people hospitalized at Montefiore after a positive COVID-19 test.
One group of 140 patients was treated with steroids within 48 hours of hospital admission, while another group of 1,666 similar patients was not, the researchers said.
Most of the patients treated with steroids received prednisone, although some received dexamethasone and methylprednisolone, they said.
Patients had a blood test to measure their levels of C-reactive protein, or CRP, which the liver produces in response to inflammation, according to the researchers.
The more CRP in the blood, the more inflammation a person has, the researchers said.
In general, patients with CRP levels greater than 20 — well above normal levels — saw the most benefit from steroid therapy, without risks for side effects, they said.
However, patients with CRP levels under 10 — a normal or low level of inflammation — had a nearly 200% increased risk for mechanical ventilation or death, according to the researchers.
By testing blood for CRP before initiating steroid treatment, clinicians might be able to identify patients who would benefit most from the approach without exposing others to unnecessary risk, the researchers said.
The findings build on those of the “Recovery” trial, a British study that found the steroid dexamethasone reduced deaths by about one-third in COVID-19 patients on ventilators and by about one-fifth among people who needed oxygen but were not on ventilators.
Meanwhile, another study addressing the treatment of inflammation in patients with COVID-19, also published Wednesday by the Proceedings of the National Academy of Sciences, found that patients with pneumonia caused by COVID-19 treated with the anti-inflammatory drug anakinra needed less oxygen and had fewer days on ventilator support.
The 22 patients in the study treated with anakinra, which is used in rheumatoid arthritis, also saw “rapid reductions in fever and systemic inflammation,” the authors said.