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.

In a paper just published on Cell Metabolism, 12,862 COVID-19 cases from 21 hospitals in Hubei Province were equally assigned to a training and a validation cohort. It was 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.

These data confirm the hypothesis expressed in the following papers that, in patients with higher NLR, the severity is determined by a proteolytic storm which is not inhibited by steroid treatment.