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We evaluated the mortality, the risk of need for mechanical ventilation (MV), or death and the risk of developing a severe acute respiratory distress syndrome (ARDS) between high (HD) and standard doses (SD) among patients with a severe COVID-19.

All consecutive confirmed COVID-19 patients admitted to a single center were selected, including those treated with steroids and an ARDS.

Patients were allocated to the HD ( 250 mgday of methylprednisolone) of corticosteroids or the SD ( 1.5 mgkgday of methylprednisolone) at discretion of treating physician.

Five hundred seventy-three patients were included: 428 (74.7) men, with a median (IQR) age of 64 (54-73) years.

In the HD group, a worse baseline respiratory situation was observed and male gender, older age, and comorbidities were significantly more common.

After adjusting by baseline characteristics, HDs were associated with a higher mortality than SD (adjusted OR 2.46, 95 CI 1.59-3.81, p.

ARDS, acute respiratory distress syndrome; RT-PCR, reverse transcriptasepolymerase chain.

ARDS, acute respiratory distress syndrome; RT-PCR, reverse transcriptasepolymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

The impact of high doses (HDs) of corticosteroids is similar to standard doses (SDs) in younger patients, but a higher mortality is observed among the elderly.

Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China.

JAMA Intern Med. 2020;180:111.

The many faces of the anti-COVID immune response.

J Exp Med. 2020;217:e20200678.

COVID-19: consider cytokine storm syndromes and immunosuppression.

S0140-6736(20)30628-0.

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