Corticosteroid therapy is now recommended as a treatment in patients with severe COVID-19. But one key question is how to objectively identify severely ill patients who may benefit from such therapy. Here, we assigned 12,862 COVID-19 cases from 21 hospitals in Hubei Province equally to a training and a validation cohort. We found that a neutrophil-to-lymphocyte ratio (NLR) > 6.11 at admission discriminated a higher risk for mortality. Importantly, however, corticosteroid treatment in such individuals was associated with a lower risk of 60-day all-cause mortality. Conversely, in individuals with an NLR ≤ 6.11 or with type 2 diabetes, corticosteroid treatment was not associated with reduced mortality, but rather increased risks of hyperglycemia and infections. These results show that in the studied cohort corticosteroid treatment is associated with beneficial outcomes in a subset of COVID-19 patients who are non-diabetic and with severe symptoms as defined by NLR.

现在推荐皮质类固醇治疗作为重症 COVID-19 患者的治疗方法。但一个关键问题是如何客观地识别可能受益于这种疗法的重症患者。在这里，我们将来自湖北省 21 家医院的 12,862 例 COVID-19 病例平均分配给训练队列和验证队列。我们发现入院时嗜中性粒细胞与淋巴细胞的比率 (NLR) > 6.11 可区分较高的死亡率风险。然而，重要的是，对这些个体进行皮质类固醇治疗与较低的 60 天全因死亡率风险相关。相反，在 NLR ≤ 6.11 或患有 2 型糖尿病的个体中，皮质类固醇治疗与死亡率降低无关，而是与高血糖和感染风险增加相关。