Published in:
Open Access
01-12-2020 | COVID-19 | Editorial
Corticosteroids in severe COVID-19: a critical view of the evidence
Authors:
Daniel De Backer, Elie Azoulay, Jean-Louis Vincent
Published in:
Critical Care
|
Issue 1/2020
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Excerpt
Since December 2019, SARS-CoV-2 has infected millions of people worldwide, causing excess deaths and a surge in demand for ICU beds. With no effective therapies against SARS-CoV-2, randomized trials of several potential therapeutic agents, including steroids, have been conducted. Although use of steroids in patients with ARDS [
1] and severe viral pneumonia [
2,
3] has been challenged, several arguments support the biological plausibility of steroid use in patients with severe COVID-19. First, autopsy studies in COVID-19 patients showed lymphocyte alveolitis, acute fibrinous injury and organizing pneumonia [
4], which are all probably steroid-sensitive. Second, COVID-19 leads to activation of endothelial cells causing not only systemic inflammation but also microvascular thrombosis, pulmonary infarcts and venous thromboembolism [
4,
5]. Admittedly, there are also arguments against steroid use. First, viral particles are often found at autopsy [
4], and steroids may decrease viral clearance. Second, steroids only influence the inflammatory component of the inflammation–thrombosis–hypoxia interaction [
6], suggesting that steroids may be less effective once thrombi have developed. …