Corticosteroids are the most important factor to reduce the mortality in patients with moderate-severe COVID-19. The aim of the study was to analyze the impact of methylprednisolone pulse (MPP) on in-hospital mortality of patients with acute respiratory distress syndrome (ARDS) due to COVID-19. We conducted a retrospective, single-center observational study We selected adult patients admitted to the hospital with the diagnosis of COVID-19 between March and June 2020. A total of 306 patients were analyzed. In-hospital crude mortality rate was 17%. Diabetes mellitus (HR 5.5, 95% CI 1.40–4.55), dementia (HR 7.7, 95% CI 4.25-13.87) and ARDS (HR 4.2, 95% CI 2.34-7.46) were associated with in -hospital mortality. In patients diagnosed of ARDS, the only in-hospital mortality risk factor was dementia (HR 5.2, 95% CI 2.44–11.07), whereas MPP was a protective factor (HR 0.2, 95% CI 0.09–0.63)