Unexpected role of corticosteroids in coronavirus disease 2019: A Saudi Arabian cohort study

Objectives: Multiple studies suggested that therapies used by individuals with respiratory illnesses to have a protective effect against coronavirus disease 2019 (COVID-19) infection. Our aim is to explore COVID-19 infection outcomes among patients with respiratory illnesses treated with corticosteroids. Methods: This was a retrospective cohort study. One hundred and twenty-six cases were recruited in the study. Among them, 63 were confirmed to be using any sort of corticosteroids to manage their respiratory illnesses, and 63 were confirmed to be non-corticosteroid users. Results: Logistic regression indicated receiving corticosteroids was a significant predictor of COVID-19 infection, with an odds ratio (OR) of 7.037 (95% confidence interval [CI]: 2.682–18.463; P < 0.001). In the overall sample, logistic regression showed that receiving corticosteroids did not significantly predict survival (OR: 4.361; 95% CI: 0.420–45.310; P = 0.218), meaning not receiving corticosteroids will lead to more death among all study samples. Among COVID-19 patients, not receiving corticosteroids was a significant predictor of mortality, with an OR of 383.423 (95% CI: 2.070–71015.113; P = 0.026), meaning not receiving corticosteroids will lead to more death once a patient has COVID-19. Age approached significance ( P = 0.071), suggesting older age may be associated with higher mortality, but gender and medical history were not significant predictors. Conclusion: While not significantly associated with survival in the overall sample, the absence of corticosteroid therapy was a significant predictor of mortality among COVID-19 patients. This suggests a potential protective effect of corticosteroids in the context of COVID-19 infection.