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VOLUME 25 , ISSUE 11 ( November, 2021 ) > List of Articles

Consensus Statement

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

Mradul K Daga, Apoorv Krishna, Bharat G Jagiasi, Himadri S Barthakur, Hrishikesh Jha, Rajesh M Shetty, Rohit Yadav, Sandeep Garg, Sivakumar M Nandakumar, Manish Munjal

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

Citation Information : Daga MK, Krishna A, Jagiasi BG, Barthakur HS, Jha H, Shetty RM, Yadav R, Garg S, Nandakumar SM, Munjal M. Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19. Indian J Crit Care Med 2021; 25 (11):1280-1285.

DOI: 10.5005/jp-journals-10071-23923

License: CC BY-NC 4.0

Published Online: 16-11-2021

Copyright Statement:  Copyright © 2021; The Author(s).


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.

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