Low-to-moderate dose corticosteroids treatment in hospitalized adults with COVID-19

Copyright © 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved..

OBJECTIVES: Use of corticosteroids is common in the treatment of coronavirus disease 2019, but clinical effectiveness is controversial. We aimed to investigate the association of corticosteroids therapy with clinical outcomes of hospitalized COVID-19 patients.

METHODS: In this single-centre, retrospective cohort study, adult patients with confirmed coronavirus disease 2019 and dead or discharged between 29 December 2019 and 15 February 2020 were studied; 1:1 propensity score matchings were performed between patients with or without corticosteroid treatment. A multivariable COX proportional hazards model was used to estimate the association between corticosteroid treatment and in-hospital mortality by taking corticosteroids as a time-varying covariate.

RESULTS: Among 646 patients, the in-hospital death rate was higher in 158 patients with corticosteroid administration (72/158, 45.6% vs. 56/488, 11.5%, p < 0.0001). After propensity score matching analysis, no significant differences were observed in in-hospital death between patients with and without corticosteroid treatment (47/124, 37.9% vs. 47/124, 37.9%, p 1.000). When patients received corticosteroids before they required nasal high-flow oxygen therapy or mechanical ventilation, the in-hospital death rate was lower than that in patients who were not administered corticosteroids (17/86, 19.8% vs. 26/86, 30.2%, log rank p 0.0102), whereas the time from admission to clinical improvement was longer (13 (IQR 10-17) days vs. 10 (IQR 8-13) days; p < 0.001). Using the Cox proportional hazards regression model accounting for time varying exposures in matched pairs, corticosteroid therapy was not associated with mortality difference (HR 0.98, 95% CI 0.93-1.03, p 0.4694).

DISCUSSION: Corticosteroids use in COVID-19 patients may not be associated with in-hospital mortality.

Media Type:

Electronic Article

Year of Publication:

2021

Contained In:

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases - Vol. 27, No. 1 (2021), p. 112-117

Language:

English

Contributors:

Liu, Zhibo
Li, Xia
Fan, Guohui
Zhou, Fei
Wang, Yeming
Huang, Lixue
Yu, Jiapei
Yang, Luning
Shang, Lianhan
Xie, Ke
Xu, Jiuyang
Huang, Zhisheng
Gu, Xiaoying
Li, Hui
Zhang, Yi
Wang, Yimin
Huang, Zhenghui
Cao, Bin

Links:

Volltext

Keywords:

Adrenal Cortex Hormones
Aged
Antiviral Agents
COVID-19
China
Corticosteroids
Critical Illness
Drug Administration Schedule
Female
Hospital Mortality
Hospitals
Humans
Journal Article
Length of Stay
Male
Middle Aged
Outcome
Proportional Hazards Models
Respiration, Artificial
Retrospective Studies
SARS-CoV-2
SARS-CoV-2 pneumonia
Severity of Illness Index
Treatment
Treatment Outcome

Notes:

Date Completed 31.12.2020

Date Revised 31.12.2020

published: Print-Electronic

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1016/j.cmi.2020.09.045

PMID:

33007478

PPN (Catalogue-ID):

NLM316744522