Rational use of corticosteroid treatment in the early phase of severe COVID-19

Mechanisms of hypoxemia in COVID-19 pneumonia include pulmonary inflammation, alveolar collapse, atelectasis, and pulmonary intravascular coagulopathy due to a hyperinflammatory response to SARS-CoV-2 infection. Systemic corticosteroids are widely applied as a standard treatment for hospitalized COVID-19 patients after several studies have shown favorable outcomes. However, the standard dosing and tailoring of corticosteroids in COVID-19 patients have not been established. Differences in dosing and timing of corticosteroid use may affect the outcome of COVID-19 patients. Inappropriate use of corticosteroids can lead to less benefit and potentially harmful adverse events. Dexamethasone is the most widely used corticosteroid as a result of the positive outcome from the RECOVERY study and its high anti-inflammatory potency. Although several studies have shown the benefit of higher dose corticosteroids in severe COVID-19 patients, serious adverse events associated with the use of corticosteroids, such as superimposed bacterial and/or fungal infections, have also been observed. Therefore, in this article, we reviewed current evidence of corticosteroid usage in COVID-19 patients and suggested a strategy for tailoring corticosteroid usage according to the clinical severity and risk of the patients.