Influence of Corticosteroid Timing on the Progression of Severe COVID-19: A Retrospective Study at a Teaching Hospital From Latin America

Background The SARS-CoV-2 pandemic has posed a significant challenge to healthcare systems. Corticosteroids have become a cornerstone of treatment due to their immunomodulatory potential; however, their association with adverse events and disease progression remains insufficiently described. This study aims to provide new insights into the outcomes related to the timing of therapy initiation and disease progression in adult patients with severe COVID-19. Methods A retrospective longitudinal study derived from the institutional COVID-19 registry (RECOVID), with data from March 2020 to December 2022, was conducted. Demographic data, outcomes, and complications were analyzed. Two groups were established based on the day of corticosteroid initiation relative to the confirmatory test. Group 1 included those who started therapy before 7 days, and group 2 included those who began therapy on or after 7 days. Results A total of 1039 patients were included. Group 2 presented a higher number of events of ventilator-associated pneumonia ( P = 0.004), a greater need for renal replacement therapy (14.5% vs 7.5%, P = 0.024), and a higher frequency of bacterial superinfections (31.4% vs 23.1%, P = 0.044). The evaluation of favorable response was 33.8% for Group 1 compared to 44.4% for Group 2 ( P = 0.010). Conclusions The role of corticosteroids in treating COVID-19 should be considered, especially in patients with preexisting comorbidities, considering the timing of corticosteroid therapy initiation.