High-dose corticosteroid therapy in critically ill COVID-19 patients: insights from Suriname

Background: High-dose corticosteroids (HDS) are an established treatment for non-COVID-19 acute respiratory distress syndrome (ARDS) because of their anti-inflammatory effects. In COVID-19 patients requiring oxygen therapy or invasive mechanical ventilation, 6mg dexamethasone daily reduces mortality. This study evaluated the effect of HDS compared to standard-dose dexamethasone on IC mortality and superinfection rates in ICU patients with COVID-19 in Suriname. Methods: : This retrospective cohort study included patients with PCR-confirmed severe COVID-19 pneumonia admitted to ICUs in Suriname, between June 2020 and October 2021. Patients received standard-dose corticosteroids (SDS) and/or HDS (dexamethasone >6 mg daily or equivalent). Treatment with HDS was analyzed as a time-dependent exposure. Predictors of mortality were identified through logistic regression and incorporated as covariates in a time-updated Cox survival model. Chi-square test compared bacterial superinfections between treatment groups. Results: : Of 103 included patients, 36(35%) received HDS. In multivariable analysis, only age (OR 1.10 per year, p=0.022) and invasive mechanical ventilation (OR 8.28, p=0.046) were associated with mortality. Time-updated survival analysis showed no significant harm or benefit with HDS (HR 1.99, 95% CI:0.78-5.09, p=0.15) and no increased superinfection rates (p=1.00). Conclusion: This first Surinamese study of HDS in severe COVID-19 pneumonia found no improved outcomes compared to SDS, nor increased bacterial superinfections. These findings do not support corticosteroid dose escalation beyond standard dexamethasone therapy in severe COVID-19 pneumonia.