Blood test identifies which coronavirus patients may be helped or harmed by steroid treatment

A simple blood test may identify which coronavirus patients may be helped by steroid treatments and which ones may actually be harmed by using them in the initial treatment of the disease. 

Researchers at Albert Einstein College of Medicine and Montefiore Health System in the Bronx, N.Y., performed an observational study that not only confirmed results of a large British trial of steroid use for COVID-19 patients but also advanced the study by identifying which patients may benefit and which would potentially be in danger from initial steroid treatment, according to the study. 

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"Our study is consistent with the promising findings from Britain, but for the first time, we are able to demonstrate that people can see the same life-saving benefits with steroid formulations other than dexamethasone," said Dr. Marla Keller, vice chair for research in the Department of Medicine at Einstein and Montefiore, in a hospital news release.

"We also found that a common blood test may identify the best candidates for steroid treatment," Keller, the study's lead author, added. 

The study involved nearly 3,000 patients hospitalized at Montefiore who tested positive with COVID-19. One group of 140 patients received steroids in the form of prednisone, dexamethasone, and methylprednisone within 48 hours of their hospital admission. Nearly all patients had a blood test to measure the amount of inflammation in their bodies by measuring their C-reactive protein (CRP) level.

CRP is produced in your body in response to inflammation and higher levels correlate with higher amounts of inflammation present. A normal CRP level reported in the study is below 0.8 milligrams per deciliter of blood.

"We found that in patients with high levels of inflammation, namely a CRP level greater than 20, steroids were associated with a 75 percent reduction in the risk of going on mechanical ventilation or dying," Keller said in the release. "Critically, we also found that for patients with a lower level of inflammation — CRP levels less than 10 — steroid use was associated with an almost 200 percent increased risk of going on mechanical ventilation or death." 

Health experts have said that many coronavirus-related deaths are due to the body’s intense inflammatory response, which results in severe lung damage.

"Our findings suggest that steroid therapy should be reserved for people with high inflammation, as indicated by markedly elevated CRP levels," said Dr. William Southern, professor of medicine and chief of the Division of Hospital Medicine at Einstein and Montefiore, in the release. 

"It’s a different story for people who do not have significant inflammation: For them, any benefit is outweighed by the risks from using steroids," Southern, the study’s senior author, added. 

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The Bronx-based study expanded on a large scale British study called the RECOVERY trial that found dexamethasone, a steroid, can reduce COVID-19 related deaths by one third in ventilated patients and by one fifth in other patients who required oxygen supplementation. The study found that steroids did not benefit and could possibly harm patients who did not need extra oxygen to breathe.

The Albert Einstein College of Medicine and Montefiore Health System study was published this week in the peer-reviewed Journal of Hospital Medicine.