Yupeng Li,1 Chuanchuan Dong,1 Yanqing Xing,1 Xinkai Ma,1 Zhen Ma,1 Lulu Zhang,1 Xianglin Du,1 Liting Feng,1 Rujie Huo,1 Qian Nan Wu,1 Peiqi Li,1 Fei Hu,1 Dai Liu,1 Yanting Dong,1 Erjing Cheng,1 Xinrui Tian,1,* Xinli Tian2,* 

1The Second Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China; 2Chinese PLA General Hospital, Beijing, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xinrui Tian, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Xinghualing District, Taiyuan, Shanxi, People’s Republic of China, Tel +868613834575570, Email tianxr@126.com; 18600501329@126.com

Purpose: To evaluate the necessity of the application of glucocorticoid (GC) in moderate COVID-19 patients, and which is the optimal choice between methylprednisolone (MP) and dexamethasone (DEX) in the clinical use of GC in different types of COVID-19 patients.
Patients and Methods: The study included patients with COVID-19 in Shanxi, China, from December 18, 2022, to March 1, 2023. The main clinical outcomes were 30-day mortality, disease exacerbations, and hospitalization days. Secondary outcomes included the demand for non-invasive ventilator-assisted ventilation (NIPPV)/invasive mechanical ventilation (IMV), the need for GC regimen escalation in follow-up treatment, duration of GC treatment, and complications including hyperglycemia and fungal infection.
Results: In moderate patients (N = 351), the rate of exacerbation and the need for GC regimen escalation in follow-up treatment was highest in the no-use GC group (P = 0.025, P = 0.01), the rate of fungal infections was highest in the DEX group (P = 0.038), and MP 40 mg/day or DEX 5 mg/day reduced exacerbations with consistent effects. In severe patients (N = 371), the two GC regimens do not affect their 30-day mortality and exacerbation rate, but the number of hospital days was significantly lower in the MP group compared with the DEX group (P < 0.001).
Conclusion: GC use is beneficial in mitigating exacerbations in moderate patients and in patients with moderate COVID-19. In severe patients, MP reduces the number of hospitalization days compared with DEX and may be a superior choice.

Keywords: COVID-19, Glucocorticoid, Methylprednisolone, Dexamethasone