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SARS-CoV-2 causes ARDS, a cytokine storm and excessive inflammation... High-dose corticosteroid therapy may be indicated in patients who develop pulmonary fibrosis. The aim of the study was to identify factors leading to failure of high-dose corticosteroid therapy according to the Meduri protocol. This prospective cohort study was conducted in the intensive care unit of the Taher Sfar Hospital in Mahdia. All patients hospitalized with SARS-CoV-2 pneumonia received methylprednisolone 2 mg/kg/d in tapering doses over one month. Out of 178 patients, treatment success was 33.7%, with a mortality rate of 61%. In multivariate analysis, SAPS II score (OR=0.938, CI95% [0.895-0.982], p=0.007) and NIV use (OR=0.416, CI95% [0.187-0.925], p=0.031) were independently associated with failure. The SAPS II threshold was 23.5, with a sensitivity of 75%, a specificity of 61%, a positive predictive value of 54.55%, a negative predictive value of 79.46% and an area under the curve of 0.724. In conclusion, SAPS II score and use of NIV as failure factors.