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Peer-reviewedCC BY-NCArchives of academic emergency medicine

Comparative 28-day Outcomes of Pulse-Dose Methylprednisolone versus Prolonged Low-Dose Dexamethasone in Hospitalized COVID-19 Pneumonia: A Cohort Study.

  • Pitsucha Sanguanwit1
  • Poonyanutch Rinprasertmeechai1
  • Sittichok Leela-Amornsin2
  1. 1Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
  2. 2Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, 10540, Thailand.
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Abstract

Introduction

Corticosteroids are widely used in COVID-19 pneumonia; however, the optimal regimen remains uncertain. We compared clinical outcomes between pulse-dose methylprednisolone and prolonged low-dose dexamethasone in hospitalized patients with COVID-19 pneumonia.Methods

In this retrospective cohort study, adult patients hospitalized with COVID-19 pneumonia (18 April-30 August 2021), who received either pulse-dose methylprednisolone or prolonged low-dose dexamethasone, were compared regarding 28-day mortality, in-hospital mortality, and treatment-free days. Multivariable Cox regression and propensity score matching (PSM) were used to adjust for confounding.Results

Among 460 patients (269 pulse-dose methylprednisolone, 191 prolonged low-dose dexamethasone), no significant difference in 28-day mortality was observed in multivariable analysis (aHR: 1.51; 95% CI: 0.74-3.09, p = 0.26). After PSM, 28-day mortality remained similar (HR: 1.40; 95% CI: 0.64-3.06; p = 0.38), although a trend toward higher in-hospital mortality was noted with pulse-dose methylprednisolone (HR: 2.07; 95% CI: 0.96-4.42; p = 0.06).Conclusion

Pulse-dose methylprednisolone was not associated with a significant difference in 28-day mortality compared with prolonged low-dose dexamethasone. A trend toward higher in-hospital mortality was observed with pulse-dose methylprednisolone, warranting cautious interpretation due to potential residual confounding.

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Cite

BibTeXRIS
BibTeX
@article{sanguanwit2026comparative,
  title = {{Comparative 28-day Outcomes of Pulse-Dose Methylprednisolone versus Prolonged Low-Dose Dexamethasone in Hospitalized COVID-19 Pneumonia: A Cohort Study.}},
  author = {Pitsucha Sanguanwit and Poonyanutch Rinprasertmeechai and Sittichok Leela-Amornsin},
  journal = {Archives of academic emergency medicine},
  year = {2026},
  month = sep,
  doi = {10.22037/aaem.v14i1.3063},
  url = {https://europepmc.org/article/MED/42936320},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Comparative 28-day Outcomes of Pulse-Dose Methylprednisolone versus Prolonged Low-Dose Dexamethasone in Hospitalized COVID-19 Pneumonia: A Cohort Study.
AU  - Pitsucha Sanguanwit
AU  - Poonyanutch Rinprasertmeechai
AU  - Sittichok Leela-Amornsin
PY  - 2026
DA  - 2026/09/10
JO  - Archives of academic emergency medicine
DO  - 10.22037/aaem.v14i1.3063
UR  - https://europepmc.org/article/MED/42936320
AB  - Introduction  Corticosteroids are widely used in COVID-19 pneumonia; however, the optimal regimen remains uncertain. We compared clinical outcomes between pulse-dose methylprednisolone and prolonged low-dose dexamethasone in hospitalized patients with COVID-19 pneumonia.Methods  In this retrospective cohort study, adult patients hospitalized with COVID-19 pneumonia (18 April-30 August 2021), who received either pulse-dose methylprednisolone or prolonged low-dose dexamethasone, were compared regarding 28-day mortality, in-hospital mortality, and treatment-free days. Multivariable Cox regression and propensity score matching (PSM) were used to adjust for confounding.Results  Among 460 patients (269 pulse-dose methylprednisolone, 191 prolonged low-dose dexamethasone), no significant difference in 28-day mortality was observed in multivariable analysis (aHR: 1.51; 95% CI: 0.74-3.09, p = 0.26). After PSM, 28-day mortality remained similar (HR: 1.40; 95% CI: 0.64-3.06; p = 0.38), although a trend toward higher in-hospital mortality was noted with pulse-dose methylprednisolone (HR: 2.07; 95% CI: 0.96-4.42; p = 0.06).Conclusion  Pulse-dose methylprednisolone was not associated with a significant difference in 28-day mortality compared with prolonged low-dose dexamethasone. A trend toward higher in-hospital mortality was observed with pulse-dose methylprednisolone, warranting cautious interpretation due to potential residual confounding.
SN  - 2645-4904
ER  -