Use of corticosteroids in COVID-19 patients vs. acute respiratory distress syndrome of other etiologies : are there any differences ?

• Published in: Qatar medical journal Vol. 2021; no. 2; pp. 1 - 11
• Main Authors: Moreno-Montoya, José, Hoz-Valle, José A. De la, Barrera-López, Pedro, Pérez-Riveros, Erika D., Roldan, Mariana Vásquez, Ballesteros, Silvia Marcela
• Format: Journal Article
• Language: English
• Published: Doha, Qatar Hamad Medical Corporation 01-01-2021; HBKU Press
• ISSN: 0253-8253; 2227-0426
• DOI: 10.5339/qmj.2021.30

The disease resulting from infection by severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2),
widely known as coronavirus disease 2019 (COVID-
19), has been classified as a global pandemic. It is
characterized by respiratory compromise, which may
include multisystemic involvement due to endothelial
damage as well as activation of multiple thromboin-
flammatory mechanisms,1,2 leading to various serious
clinical stages such as multiple organ failure and death
due to Acute Respiratory Distress Syndrome (ARDS).1
In addition, the increased demand for health services,
including the need for intensive care units and
advanced vital resources such as mechanical venti-
lation or extracorporeal membrane oxygenation and
trained personnel, poses serious challenges in
choosing a suitable treatment.3,4
In the absence of a standard treatment, the clinical
approach to those affected has focused on pharma-
cological management, particularly the use of
antivirals and immunomodulators.5 According to the
phases of the immunological response,6 the use of
glucocorticoids has become widespread given its
effect on the control of the inflammatory cascade
from its origin (blockade of phospholipase A2) to its
wide pharmacological availability and low cost.
To date, the results have been controversial. At the
beginning of the pandemic, these drugs were not
recommended for use in COVID-19 patients.7
Nonetheless, current preliminary results of a clinical
trial in the RECOVERY group show a decrease in
mortality in patients receiving dexamethasone,8
raising the possibility of the systematic use of
glucocorticoids for COVID-19 disease.9
The purpose of this review is to perform a rapid
assessment of the evidence for and against the use of
glucocorticoids to prevent progression to ARDS and
related mortality in both COVID-19 and ARDS
mediated by other pathologies.