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High-dose corticosteroids are associated with higher mortality in patients with COVID-19 ARDS: Results from a

Anders Boyd1, Katrijn Daenen2, Sarah Stoof3

  • 1Amsterdam UMC, Location University of Amsterdam, Department of Infectious Diseases, Amsterdam, the Netherlands; Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, the Netherlands; Stichting HIV Monitoring, Amsterdam, the Netherlands.

Journal of Critical Care
|July 1, 2026
PubMed

Insights

High-dose corticosteroids increased mortality in severe COVID-19 ARDS patients admitted to the ICU. Standard-dose therapy is associated with better outcomes within 28 days post-admission.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Optimal corticosteroid dosing for severe COVID-19 ARDS in the ICU remains uncertain.
  • This study investigated mortality differences between high-dose and standard-dose corticosteroid treatments.

Purpose of the Study:

  • To compare mortality rates in intensive care unit (ICU) patients with COVID-19 acute respiratory distress syndrome (ARDS) based on corticosteroid dosage.
  • To evaluate the impact of high-dose versus standard-dose corticosteroids on 28-day mortality.

Main Methods:

  • Prospective cohort study of 848 adult COVID-19 ARDS patients across 22 Dutch centers (March 2020-January 2021).
  • Marginal structural models with stabilized inverse probability of treatment weights were used to compare mortality hazards.
  • Adjusted for time-varying confounding related to the initiation of high-dose corticosteroid therapy.

Main Results:

  • High-dose corticosteroids ( >6 mg dexamethasone equivalent) were administered to 378 patients, standard-dose (6 mg) to 470.
  • High-dose therapy was associated with increased 28-day mortality (hazard ratio = 2.45, 95% CI = 1.97-3.05).
  • Increased risk was observed in male patients and those initiating therapy more than one day after ICU admission.

Conclusions:

  • High-dose corticosteroid use in COVID-19 ARDS patients is linked to elevated mortality within 28 days of ICU admission.
  • Standard-dose corticosteroids may represent a safer treatment strategy for this patient population.
Abstract

Keywords:
COVID-19CorticosteroidsDoseIntensive care unitTreatment optimization

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