Corticosteroid outcome may be dependent of duration of use in severe COVID-19
BACKGROUND/AIMS: For patients hospitalized with coronavirus disease 2019 (COVID-19) who require supplemental oxygen, the evidence of the optimal duration of corticosteroid is limited. This study aims to identify whether long-term use of corticosteroids is associated with decreased mortality.
METHODS: Between February 10, 2020 and October 31, 2021, we analyzed consecutive hospitalized patients with COVID-19 with severe hypoxemia. The patients were divided into short-term (≤ 14 days) and long-term (> 14 days) corticosteroid users. The primary outcome was 60-day mortality. We performed propensity score (PS) analysis to mitigate the effect of confounders and conducted Kaplan-Meier curve analysis.
RESULTS: There were 141 (52%) short-term users and 130 (48%) long-term corticosteroid users. The median age was 68 years and the median PaO2/FiO2 at admission was 158. Of the patients, 40.6% required high-flow nasal cannula, 48.3% required mechanical ventilation, and 11.1% required extracorporeal membrane oxygenation. The overall 60-day mortality rate was 23.2%, and that of patients with hospital-acquired pneumonia (HAP) was 22.9%. The Kaplan-Meier curve for 60- day survival in the PS-matched cohort showed that corticosteroid for > 14 days was associated with decreased mortality (p = 0.0033). There were no significant differences in bacteremia and HAP between the groups. An adjusted odds ratio for the risk of 60-day mortality in short-term users was 5.53 (95% confidence interval, 1.90-18.26; p = 0.003).
CONCLUSION: For patients with severe COVID-19, long-term use of corticosteroids was associated with decreased mortality, with no increase in nosocomial complications. Corticosteroid use for > 14 days can benefit patients with severe COVID-19.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:38 |
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| Enthalten in: |
The Korean journal of internal medicine - 38(2023), 3 vom: 01. Mai, Seite 382-392 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kim, Jin Hyoung [VerfasserIn] |
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| Links: |
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| Themen: |
Adrenal Cortex Hormones |
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| Anmerkungen: |
Date Completed 12.05.2023 Date Revised 16.05.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.3904/kjim.2022.201 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM355427850 |
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| 100 | 1 | |a Kim, Jin Hyoung |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Corticosteroid outcome may be dependent of duration of use in severe COVID-19 |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND/AIMS: For patients hospitalized with coronavirus disease 2019 (COVID-19) who require supplemental oxygen, the evidence of the optimal duration of corticosteroid is limited. This study aims to identify whether long-term use of corticosteroids is associated with decreased mortality | ||
| 520 | |a METHODS: Between February 10, 2020 and October 31, 2021, we analyzed consecutive hospitalized patients with COVID-19 with severe hypoxemia. The patients were divided into short-term (≤ 14 days) and long-term (> 14 days) corticosteroid users. The primary outcome was 60-day mortality. We performed propensity score (PS) analysis to mitigate the effect of confounders and conducted Kaplan-Meier curve analysis | ||
| 520 | |a RESULTS: There were 141 (52%) short-term users and 130 (48%) long-term corticosteroid users. The median age was 68 years and the median PaO2/FiO2 at admission was 158. Of the patients, 40.6% required high-flow nasal cannula, 48.3% required mechanical ventilation, and 11.1% required extracorporeal membrane oxygenation. The overall 60-day mortality rate was 23.2%, and that of patients with hospital-acquired pneumonia (HAP) was 22.9%. The Kaplan-Meier curve for 60- day survival in the PS-matched cohort showed that corticosteroid for > 14 days was associated with decreased mortality (p = 0.0033). There were no significant differences in bacteremia and HAP between the groups. An adjusted odds ratio for the risk of 60-day mortality in short-term users was 5.53 (95% confidence interval, 1.90-18.26; p = 0.003) | ||
| 520 | |a CONCLUSION: For patients with severe COVID-19, long-term use of corticosteroids was associated with decreased mortality, with no increase in nosocomial complications. Corticosteroid use for > 14 days can benefit patients with severe COVID-19 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Mortality | |
| 650 | 4 | |a Oxygen inhalation therapy | |
| 650 | 4 | |a Respiration, Artificial | |
| 650 | 4 | |a Steroids | |
| 650 | 7 | |a Adrenal Cortex Hormones |2 NLM | |
| 700 | 1 | |a Na, Yong Sub |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Song-I |e verfasserin |4 aut | |
| 700 | 1 | |a Moon, Youn Young |e verfasserin |4 aut | |
| 700 | 1 | |a Hwang, Beom Seuk |e verfasserin |4 aut | |
| 700 | 1 | |a Baek, Ae-Rin |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Won-Young |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Bo Young |e verfasserin |4 aut | |
| 700 | 1 | |a Seong, Gil Myeong |e verfasserin |4 aut | |
| 700 | 1 | |a Baek, Moon Seong |e verfasserin |4 aut | |
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