Respiratory failure & ventilation
High-dose corticosteroids are associated with higher mortality in patients with COVID-19 ARDS: Results from a nationwide observational study
Main finding · MortalityResult — go to the resultHazard ratio 2.45 95% CI 1.97–3.05Authors' conclusion
In patients with COVID-19 ARDS, high-dose corticosteroids were associated with higher mortality during the first 28 days after ICU admission.
Study context
- Population
- Adults with COVID-19 ARDS (Berlin criteria) in the intensive care unit (ICU), 22 centres in the Netherlands, March 2020–January 2021analysed
- Participants
- 848 adults
- Exposure
- High-dose vs standard-dose corticosteroids
- High-dosen = 378
- Standard-dosen = 470reference
- Outcome
- Mortality
- Follow-up
- Median 28 days
Methodological detailsmulticentre, marginal structural models, stabilized inverse probability of treatment weights, emulated per-protocol analysis
- Multicentre
- Marginal structural models
- Stabilized inverse probability of treatment weights
- Emulated per-protocol analysis
Main finding
As reported in the abstract
median 28 days of follow-up
Hazard ratio
2.45
95% CI 1.97–3.05
Events by group
High-dose vs Standard-dose
HR 2.45 (95% CI 1.97–3.05)
Observational data: associations, not effects.
Further findings
Mortality risk by sex and timing of initiation (subgroup)
- Risk higher in male patients or with late initiation (>1 day) of high-dose therapy
Timing of high-dose initiation
- Started within first day after ICU admission
- 63 (16.7%)
- Started later, median 9 days (IQR 4-14) after admission
- 315(83.3%)
Original publication
High-dose corticosteroids are associated with higher mortality in patients with COVID-19 ARDS: Results from a nationwide observational study. J Crit Care. Published 1 July 2026. doi:10.
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