Association of early steroid administration with outcomes of children hospitalized for COVID-19 without multisystem inflammatory syndrome in children


Sandeep Tripathi, University of Illinois College of Medicine at Peoria and OSF HealthCare, Children's Hospital of illinois, Peoria.
Meghana Nadiger, University of Illinois College of Medicine at Peoria and OSF HealthCare, Children's Hospital of illinois, Peoria.
Jeremy S. McGarvey, Healthcare Analytics, OSF Healthcare, Peoria, Illinois.
Aaron A. Harthan, Department of Clinical Pharmacy, OSF Saint Francis Medical Center, Peoria, Illinois.
Monica Lombardo, Division of Clinical Research, Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria.
Varsha P. Gharpure, Advocate Aurora HealthFollow
Nicholas Perkins, Department of Medicine, Prisma Health, Greenville, South Carolina.
Kathleen Chiotos, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Imran A. Sayed, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, Denver.
Erica C. Bjornstad, University of Alabama at Birmingham.
Utpal S. Bhalala, Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas.
Umamaheswara Raju, Gandhi Medical College and Hospital, Hyderabad, India.
Aaron S. Miller, Cardinal Glennon Children's Hospital, St Louis, Missouri.
Heda Dapul, Hassenfeld Children's Hospital at NYU Langone, New York, New York.
Vicki Montgomery, University of Louisville and Norton Children's Hospital, Louisville, Kentucky.
Karen Boman, Society of Critical Care Medicine, Chicago, Illinois.
Grace M. Arteaga, Mayo Clinic, Rochester, Minnesota.
Vikas Bansal, Mayo Clinic, Rochester, Minnesota.
Neha Deo, Mayo Clinic Alix School of Medicine, Rochester, Minnesota.
Aysun Tekin, Mayo Clinic, Rochester, Minnesota.
Ognjen Gajic, Mayo Clinic, Rochester, Minnesota.
Vishakha K. Kumar, Society of Critical Care Medicine, Chicago, Illinois.
Rahul Kashyap, Mayo Clinic, Rochester, Minnesota.
Allan J. Walkey, The Pulmonary Center, Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.


Advocate Children's Hospital


Importance: There is limited evidence for therapeutic options for pediatric COVID-19 outside of multisystem inflammatory syndrome in children (MIS-C).

Objective: To determine whether the use of steroids within 2 days of admission for non-MIS-C COVID-19 in children is associated with hospital length of stay (LOS). The secondary objective was to determine their association with intensive care unit (ICU) LOS, inflammation, and fever defervescence.

Design, setting, and participants: This cohort study analyzed data retrospectively for children (<18 years) who required hospitalization for non-MIS-C COVID-19. Data from March 2020 through September 2021 were provided by 58 hospitals in 7 countries who participate in the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry.

Exposure: Administration of steroids within 2 days of admission.

Main outcomes and measures: Length of stay in the hospital and ICU. Adjustment for confounders was done by mixed linear regression and propensity score matching.

Results: A total of 1163 patients met inclusion criteria and had a median (IQR) age of 7 years (0.9-14.3). Almost half of all patients (601/1163, 51.7%) were male, 33.8% (392/1163) were non-Hispanic White, and 27.9% (324/1163) were Hispanic. Of the study population, 184 patients (15.8%) received steroids within 2 days of admission, and 979 (84.2%) did not receive steroids within the first 2 days. Among 1163 patients, 658 (56.5%) required respiratory support during hospitalization. Overall, patients in the steroids group were older and had greater severity of illness, and a larger proportion required respiratory and vasoactive support. On multivariable linear regression, after controlling for treatment with remdesivir within 2 days, country, race and ethnicity, obesity and comorbidity, number of abnormal inflammatory mediators, age, bacterial or viral coinfection, and disease severity according to ICU admission within first 2 days or World Health Organization ordinal scale of 4 or higher on admission, with a random intercept for the site, early steroid treatment was not significantly associated with hospital LOS (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Separate analyses for patients with an LOS of 2 days or longer (n = 729), those receiving respiratory support at admission (n = 286), and propensity score-matched patients also showed no significant association between steroids and LOS. Early steroid treatment was not associated with ICU LOS, fever defervescence by day 3, or normalization of inflammatory mediators.

Conclusions and relevance: Steroid treatment within 2 days of hospital admission in a heterogeneous cohort of pediatric patients hospitalized for COVID-19 without MIS-C did not have a statistically significant association with hospital LOS.

Document Type


PubMed ID