Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19

Prashant Nasa; Dhruva Chaudhry; Deepak Govil; Mradul K Daga; Ravi Jain; Akshaykumar A Chhallani; Apoorv Krishna; Bharat G Jagiasi; Deven Juneja; Himadri S Barthakur; Hrishikesh Jha; Mohan Gurjar; Pradeep Rangappa; Raghunath Aladakatti; Rajesh C Mishra; Rajesh M Shetty; Rohit Yadav; Sandeep Garg; Sivakumar M Nandakumar; Srinivas Samavedam; Sumit Ray; Vijay Hadda; Yash Javeri; Manish Munjal

doi:10.5005/jp-journals-10071-23923

Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19

Indian J Crit Care Med. 2021 Nov;25(11):1280-1285. doi: 10.5005/jp-journals-10071-23923.

Authors

Prashant Nasa¹, Dhruva Chaudhry², Deepak Govil³, Mradul K Daga⁴, Ravi Jain⁵, Akshaykumar A Chhallani⁶, Apoorv Krishna⁷, Bharat G Jagiasi⁸, Deven Juneja⁹, Himadri S Barthakur¹⁰, Hrishikesh Jha¹¹, Mohan Gurjar¹², Pradeep Rangappa¹³, Raghunath Aladakatti¹⁴, Rajesh C Mishra¹⁵, Rajesh M Shetty¹⁶, Rohit Yadav¹⁷, Sandeep Garg¹⁸, Sivakumar M Nandakumar¹⁹, Srinivas Samavedam²⁰, Sumit Ray²¹, Vijay Hadda²², Yash Javeri²³, Manish Munjal²⁴

Affiliations

¹ Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates.
² Professor and Head, Pulmonary and Critical Care Medicine, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana, India.
³ Institute of Critical Care and Anesthesia, Medanta-The Medicity, Gurgaon, Haryana, India.
⁴ Department of Medicine, Maulana Azad Medical College, Delhi, India.
⁵ Department of Critical Care Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India.
⁶ Akshjot Clinic, Mumbai, Maharashtra, India.
⁷ Department of Pulmonology and Critical Care, Hospital Regency Health, Kanpur, Uttar Pradesh, India.
⁸ Department of Critical Care, Reliance Hospital, Navimumbai, Maharashtra, India.
⁹ Institute of Critical Care Medicine, Max Super Speciality Hospital, Delhi, India.
¹⁰ Department of Internal Medicine, Barthakur Clinic, Guwahati, Assam, India.
¹¹ Incharge, ICU, MRPSH, Near RIMS, Ranchi, Jharkhand, India.
¹² Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India.
¹³ Consultant Intensive Care Physician, Columbia Asia Referral Hospitals, Yeshwantpur, Bengaluru, Karnataka, India.
¹⁴ Department of Critical Care Medicine, Gopalagowda Shathaveri Memorial Hospital, Mysuru, Karnataka, India.
¹⁵ Department of MICU, Shaibya Comprehensive Care Clinic, Ahmedabad, Gujarat, India.
¹⁶ Department of Critical Care Medicine, Manipal Hospital Whitefield, Bengaluru, Karnataka, India.
¹⁷ Consultant Critical Care Medicine, Bansal Hospital, Bhopal, Madhya Pradesh, India.
¹⁸ Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, Delhi, India.
¹⁹ Department of Critical Care, Royalcare Superspeciality Hospital, Coimbatore, Tamil Nadu, India.
²⁰ Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India.
²¹ Department of Critical Care Medicine, Holy Family Hospital, Delhi, India.
²² Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, Delhi, India.
²³ Department of Critical Care, Anesthesia and Emergency Medicine, Regency Health, Lucknow, Uttar Pradesh, India.
²⁴ Medical Director, Mangalam Medicity Hospital, Jaipur, Chairman Jigyasa Foundation, Jaipur, Rajasthan, India.

Abstract

Introduction: There is strong evidence for the use of corticosteroid in the management of severe coronavirus disease-2019 (COVID-19). However, there is still uncertainty about the timing of corticosteroids. We undertook a modified Delphi study to develop expert consensus statements on the early identification of a subset of patients from non-severe COVID-19 who may benefit from using corticosteroids.

Methods: A modified Delphi was conducted with two anonymous surveys between April 30, 2021, and May 3, 2021. An expert panel of 35 experts was selected and invited to participate through e-mail. The consensus was defined as >70% votes in multiple-choice questions (MCQ) on Likert-scale type statements, while strong consensus as >90% votes in MCQ or >50% votes for "very important" on Likert-scale questions in the final round.

Results: Twenty experts completed two rounds of the survey. There was strong consensus for the increased work of breathing (95%), a positive six-minute walk test (90%), thorax computed tomography severity score of >14/25 (85%), new-onset organ dysfunction (using clinical or biochemical criteria) (80%), and C-reactive protein >5 times the upper limit of normal (70%) as the criteria for patients' selection. The experts recommended using oral or intravenous (IV) low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5-10 days and monitoring of oxygen saturation, body temperature, clinical scoring system, blood sugar, and inflammatory markers for any "red-flag" signs.

Conclusion: The experts recommended against indiscriminate use of corticosteroids in mild to moderate COVID-19 without the signs of clinical worsening. Oral or IV low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5-10 days are recommended for patients with features of disease progression based on clinical, biochemical, or radiological criteria after 5 days from symptom onset under close monitoring.

How to cite this article: How to cite this article: Nasa P, Chaudhry D, Govil D, Daga MK, Jain R, Chhallani AA, et al. Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19. Indian J Crit Care Med 2021;25(11):1280-1285.

Keywords: Corticosteroids in moderate COVID-19; Delphi study; Non-severe COVID-19; SARS-CoV-2.

Publication types

Review