Background: the management of hospitalized COVID19 patients with acute respiratory failure (ARF) is based on respiratory support care and steroid treatment. A fixed dose of dexamethasone is associated with a reduction of mortality and ICU access according to RECOVERY trial: however, some studies has proposed pulse steroid treatment as an alternative option.

Aim and objectives: we compare pulse vs conventional steroid treatment in COVID19 hospitalized patients in terms of mortality and need for ICU

Methods: we retrospectively collected demographic and clinical data of 741 patients hospitalized at Siena COVID Unit from March 2020 to January 2022. To be included in the study, patients has to receive pulse (250-500 mg iv methylprednisolone) or conventional steroid treatment (dexamethasone 6 mg/die iv). Univariate and multivariate Cox regression analyses has been conducted to compare in-hospital mortality and ICU admission risk

Results: a total of 585 patients was enrolled in the study. Among these, 170 underwent pulse steroid treatment: these patients were significantly younger,  showed a lower Charlson comorbidity Index (CCI) and a worse paO2/FiO2 at admission than those treated with conventional steroid dosage (p<0.0001 for all). Univariate Cox regression analysis revealed a lower mortality, but not ICU admission risk, in patients treated with pulse steroids: multivariate analysis did not confirm these findings, showing no differences between the two subgroups. 

Conclusion: pulse steroid treatment was not associated with a significant benefit in mortality and ICU admission risk. Due to the relevant differences of age and severity of ARF, a randomized study is required to confirm our findings.