Methylprednisolone use in hospitalised COVID-19 patients: a retrospective study

Figures & data

Table 1. Study eligibility criteria.

Inclusion criteria	Exclusion Criteria
Adult (≥18 years old)	Pregnant women
Confirmed COVID-19 infection via RT-PCR	Given intravenous methylprednisolone for less than three days
All patients admitted in the general COVID-19 wards for COVID-19 management.	Requiring ICU admission within 48 h of admission
Initiated with methylprednisolone as part of COVID-19 treatment	Transfer out to other facilities within 10 days of illness

Figure 1. Patient selection for inclusion into the study.

Table 2. Baseline demographics, clinical characteristics and COVID-19 treatments of all eligible subjects.

Parameters (n = 278)	Measure
Age (years)
Mean (SD)	54.97 (14.439)
Age group in years, n (%)
<65 (adult)	192 (69.1)
≥65 (elderly)	86 (30.9)
Gender, n (%)
Male	171 (61.5)
Female	107 (38.5)
Ethnicity, n (%)
Malay	113 (40.6)
Chinese	64 (23.0)
Indian	21 (7.6)
Others	80 (28.8)
Smoking status, n (%)
Non-smoker	89 (32.0)
Ex-smoker	26 (9.4)
Active smoker	18 (6.5)
Unknown	145 (52.2)
Height (cm), mean (SD)	162.57 (8.348)
Weight (kg), median (IQR)	74.5 (22.0)
BMI, n = 136
Mean (SD)	28.82 (6.549)
BMI range, n (%)
<18.5	3 (2.2)
18.5–24.9	38 (27.9)
25.0–29.9	40 (29.5)
30.0 and above	55 (40.4)
Multiple comorbidities, n (%)
Mean (SD)	1.47 (1.296)
COVID-19 category, n (%)
Category 1	0 (0)
Category 2	3 (1.1)
Category 3	34 (12.2)
Category 4	230 (82.7)
Category 5	11 (4.0)
Day of illness on admission (days),
Mean (SD)	6.72 (3.055)
Oxygen requirement on admission, n (%)
Room air	37 (13.3)
Low level
Nasal prong	117 (42.1)
Medium level
Face mask	8 (2.9)
Venturi mask	44 (15.8)
High flow mask	67 (24.1)
High level
Non-invasive ventilation	3 (1.1)
Mechanical ventilation	2 (0.7)
C-reactive protein (CRP) on admission,
Median (IQR)	100.90 (106.65)
Total white blood cell (TWBC) on admission,
Median (IQR)	7.92 (4.72)
Methylprednisolone dose, n (%)
1mg/kg/d	1 (0.4)
2mg/kg/d	101 (36.3)
250mg/d	130 (46.8)
500mg/d	46 (16.5)
Timing of initiation of methylprednisolone, (days)
mean (SD)	8.43 (3.232)
Other drugs prescribed for COVID-19, n (%)
Favipiravir	100 (36.0)
Ivermectin	1 (0.4)
Dexamethasone	264 (95.0)
Anticoagulant	273 (98.2)
Tocilizumab	1 (0.4)
Baricitinib	39 (14.0)

Table 3. Clinical outcomes following the administration of methylprednisolone (n = 278).

Clinical outcomes	Frequency n (%)
In-hospital outcome
Discharge	154 (55.4)
Death	83 (29.9)
Transfer to other facilities	41 (14.7)
In-hospital mortality
Yes	83 (29.9)
No	195 (70.1)
30-day mortality
Yes	85 (30.6)
No	180 (64.7)
Unknown	13 (4.7)
Length of hospitalisation (days),
Mean (SD)	11.75 (4.832)
Timing of initiation of methylprednisolone (days),
Mean (SD)	8.43 (3.232)
C-reactive protein (CRP)
CRP trend
Day 5
Decreasing or normalised	196 (70.5)
Increasing or elevated	74 (26.6)
No data/not taken	8 (2.9)
Day 10
Decreasing or normalised	152 (54.7)
Increasing or elevated	43 (15.5)
No data/not taken	83 (29.9)
Total white blood cells (TWBC)
TWBC trend
Day 5
Decreasing or normalised	179 (64.4)
Increasing or elevated	91 (32.7)
No data/not taken	8 (2.9)
Day 10
Decreasing or normalised	121 (43.7)
Increasing or elevated	77 (27.8)
No data/not taken	79 (28.5)
Oxygen requirement
Oxygen requirement trend
Day 5
Decreasing or normalised	38 (13.7)
Increasing or elevated	232 (83.5)
No data/not taken	8 (2.9)
Day 10
Decreasing or normalised	89 (32.0)
Increasing or elevated	107(38.5)
No data/not taken	82 (29.5)
Adverse events
Hyperglycaemia	171 (61.5)
Nosocomial infection	113 (40.6)
Upper gastrointestinal bleed	5 (1.8)
Others	28 (10.1)

Table 4. Clinical outcomes following weight-based (n = 102), fixed-dose (250 mg/day), (n = 130) or fixed-dose 500 mg/day (n = 46) of methylprednisolone.

Clinical outcome	Methylprednisolone dose, n (%)			p-value
	Weight-based dose (n = 102)	Fixed dose of 250mg/day (n = 130)	Fixed dose of 500mg/day (n = 46)
In-hospital outcome
Discharge	60 (58.8)	76 (58.5)	18 (39.1)	0.023*
Death	23 (22.5)	42 (32.3)	18 (39.1)
Transfer to other facilities	19 (18.6)	12 (9.2)	10 (21.7)
30-day mortality
Yes	23 (22.5)	43 (33.1)	19 (41.3)	0.116^a
No	74 (72.5)	82 (63.1)	24 (52.2)
Unknown	5 (4.9)	5 (3.8)	3 (6.5)
Length of hospitalisation (days),
Mean (SD)	12.08 (4.181)	11.42 (5.310)	11.93 (4.800)	0.569^b
Timing of initiation of methylprednisolone (days),
Mean (SD)	8.57 (3.485)	8.29 (3.121)	8.33 (3.076)	0.815^b
C-reactive protein (CRP)
CRP trend
Day 5
Decreasing or normalised	80 (78.4)	82 (63.1)	34 (73.9)	0.133^a
Increasing or elevated	20 (19.6)	43 (33.1)	11 (23.9)
No data/not taken	2 (2.0)	5 (3.8)	1 (2.2)
Day 10
Decreasing or normalised	65 (63.7)	67 (51.5)	20 (43.5)	0.105
Increasing or elevated	13 (12.7)	19 (14.6)	11 (23.9)
No data/not taken	24 (23.5)	44 (33.8)	15 (32.6)
Total white blood cells (TWBC)
TWBC trend
Day 5
Decreasing or normalised	64 (62.7)	85 (65.4)	30 (65.2)	0.906^a
Increasing or elevated	36 (35.3)	40 (30.8)	15 (32.6)
No data/not taken	2 (2.0)	5 (3.8)	1 (2.2)
Day 10
Decreasing or normalised	55 (53.9)	49 (37.7)	17 (37.8)	0.137
Increasing or elevated	24 (23.5)	39 (30.0)	14 (31.1)
No data/not taken	23 (22.5)	42 (32.3)	14 (31.1)
Oxygen requirement
Oxygen requirement trend
Day 5
Decreasing or normalised	14 (13.7)	19 (14.7)	5 (10.9)	0.905^a
Increasing or elevated	86 (84.3)	105 (81.4)	40 (87.0)
No data/not taken	2 (2.0)	5 (3.9)	1 (2.2)
Day 10
Decreasing or normalised	40 (39.2)	39 (30.0)	10 (32.0)	0.199
Increasing or elevated	38 (37.3)	48 (36.9)	21 (45.7)
No data/not taken	24 (23.5)	43 (33.1)	15 (32.6)
Adverse events
Hyperglycaemia	55 (53.9)	83 (63.8)	33 (71.7)	0.097
Nosocomial infection	42 (41.2)	52 (40.0)	19 (41.3)	0.986
Upper gastrointestinal bleed	2 (2.0)	1 (0.8)	2 (4.3)	0.249^a
Others	11 (10.9)	10 (7.7)	7 (15.2)	0.349^a

^a Fischer’s exact test was performed as more than 20% of cells have an expected count of less than 5.

Chi-square test was performed unless otherwise stated.

^b One-way ANOVA was performed.

*p < 0.05 denotes statistical significance.