Crit Care
. 2020 Nov 10;24(1):643.
doi: 10.1186/s13054-020-03340-4.
Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis
Chaomin Wu 1 2 , Dongni Hou 2 , Chunling Du 1 , Yanping Cai 3 , Junhua Zheng 4 , Jie Xu 5 , Xiaoyan Chen 2 , Cuicui Chen 2 , Xianglin Hu 2 , Yuye Zhang 2 , Juan Song 2 , Lu Wang 2 , Yen-Cheng Chao 2 , Yun Feng 6 , Weining Xiong 7 , Dechang Chen 8 , Ming Zhong 9 , Jie Hu 2 , Jinjun Jiang 2 , Chunxue Bai 2 , Xin Zhou 10 , Jinfu Xu 11 , Yuanlin Song 12 13 14 15 16 , Fengyun Gong 17
Affiliations
- PMID: 33172477
- DOI: 10.1186/s13054-020-03340-4
Abstract
Background: The impact of corticosteroid therapy on outcomes of patients with coronavirus disease 2019 (COVID-19) is highly controversial. We aimed to compare the risk of death between COVID-19-related ARDS patients with corticosteroid treatment and those without.
Methods: In this single-center retrospective observational study, patients with ARDS caused by COVID-19 between January 20, 2020, and February 24, 2020, were enrolled. The primary outcome was 60-day in-hospital death. The exposure was prescribed systemic corticosteroids or not. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for 60-day in-hospital mortality.
Results: A total of 382 patients [60.7 ? 14.1 years old (mean ? SD), 61.3% males] were analyzed. The median of sequential organ failure assessment (SOFA) score was 2.0 (IQR 2.0-3.0). Of these cases, 94 (24.6%) patients had invasive mechanical ventilation. The number of patients received systemic corticosteroids was 226 (59.2%), and 156 (40.8%) received standard treatment. The maximum dose of corticosteroids was 80.0 (IQR 40.0-80.0) mg equivalent methylprednisolone per day, and duration of corticosteroid treatment was 7.0 (4.0-12.0) days in total. In Cox regression analysis using corticosteroid treatment as a time-varying variable, corticosteroid treatment was associated with a significant reduction in risk of in-hospital death within 60 days after adjusting for age, sex, SOFA score at hospital admission, propensity score of corticosteroid treatment, comorbidities, antiviral treatment, and respiratory supports (HR 0.42; 95% CI 0.21, 0.85; p = 0.0160). Corticosteroids were not associated with delayed viral RNA clearance in our cohort.
Conclusion: In this clinical practice setting, low-dose corticosteroid treatment was associated with reduced risk of in-hospital death within 60 days in COVID-19 patients who developed ARDS.
Keywords: Coronavirus disease 2019; Corticosteroids; Methylprednisolone; Mortality; Propensity score; Severe acute respiratory syndrome coronavirus 2.