tetano
Editor, Senior Moderator
BMC Infect Dis
. 2022 Oct 5;22(1):776.
doi: 10.1186/s12879-022-07750-3.
Real-world effectiveness of steroids in severe COVID-19: a retrospective cohort study
Wenjuan Wang[SUP] 1 [/SUP], Luke B Snell[SUP] 2 3 4 [/SUP], Davide Ferrari[SUP] 5 [/SUP], Anna L Goodman[SUP] 3 [/SUP], Nicholas M Price[SUP] 3 [/SUP], Charles D Wolfe[SUP] 5 4 [/SUP], Vasa Curcin[SUP] 5 4 [/SUP], Jonathan D Edgeworth[SUP] #[/SUP][SUP] 2 3 4 [/SUP], Yanzhong Wang[SUP] #[/SUP][SUP] 5 4 [/SUP]
Affiliations
Abstract
Introduction: Randomised controlled trials have shown that steroids reduce the risk of dying in patients with severe Coronavirus disease 2019 (COVID-19), whilst many real-world studies have failed to replicate this result. We aim to investigate real-world effectiveness of steroids in severe COVID-19.
Methods: Clinical, demographic, and viral genome data extracted from electronic patient record (EPR) was analysed from all SARS-CoV-2 RNA positive patients admitted with severe COVID-19, defined by hypoxia at presentation, between March 13th 2020 and May 27th 2021. Steroid treatment was measured by the number of prescription-days with dexamethasone, hydrocortisone, prednisolone or methylprednisolone. The association between steroid > 3 days treatment and disease outcome was explored using multivariable cox proportional hazards models with adjustment for confounders (including age, gender, ethnicity, co-morbidities and SARS-CoV-2 variant). The outcome was in-hospital mortality.
Results: 1100 severe COVID-19 cases were identified having crude hospital mortality of 15.3%. 793/1100 (72.1%) individuals were treated with steroids and 513/1100 (46.6%) received steroid ≤ 3 days. From the multivariate model, steroid > 3 days was associated with decreased hazard of in-hospital mortality (HR: 0.47 (95% CI: 0.31-0.72)).
Conclusion: The protective effect of steroid treatment for severe COVID-19 reported in randomised clinical trials was replicated in this retrospective study of a large real-world cohort.
Keywords: COVID-19; Mortality; Retrospective cohort study; Steroids.
. 2022 Oct 5;22(1):776.
doi: 10.1186/s12879-022-07750-3.
Real-world effectiveness of steroids in severe COVID-19: a retrospective cohort study
Wenjuan Wang[SUP] 1 [/SUP], Luke B Snell[SUP] 2 3 4 [/SUP], Davide Ferrari[SUP] 5 [/SUP], Anna L Goodman[SUP] 3 [/SUP], Nicholas M Price[SUP] 3 [/SUP], Charles D Wolfe[SUP] 5 4 [/SUP], Vasa Curcin[SUP] 5 4 [/SUP], Jonathan D Edgeworth[SUP] #[/SUP][SUP] 2 3 4 [/SUP], Yanzhong Wang[SUP] #[/SUP][SUP] 5 4 [/SUP]
Affiliations
- PMID: 36199017
- DOI: 10.1186/s12879-022-07750-3
Abstract
Introduction: Randomised controlled trials have shown that steroids reduce the risk of dying in patients with severe Coronavirus disease 2019 (COVID-19), whilst many real-world studies have failed to replicate this result. We aim to investigate real-world effectiveness of steroids in severe COVID-19.
Methods: Clinical, demographic, and viral genome data extracted from electronic patient record (EPR) was analysed from all SARS-CoV-2 RNA positive patients admitted with severe COVID-19, defined by hypoxia at presentation, between March 13th 2020 and May 27th 2021. Steroid treatment was measured by the number of prescription-days with dexamethasone, hydrocortisone, prednisolone or methylprednisolone. The association between steroid > 3 days treatment and disease outcome was explored using multivariable cox proportional hazards models with adjustment for confounders (including age, gender, ethnicity, co-morbidities and SARS-CoV-2 variant). The outcome was in-hospital mortality.
Results: 1100 severe COVID-19 cases were identified having crude hospital mortality of 15.3%. 793/1100 (72.1%) individuals were treated with steroids and 513/1100 (46.6%) received steroid ≤ 3 days. From the multivariate model, steroid > 3 days was associated with decreased hazard of in-hospital mortality (HR: 0.47 (95% CI: 0.31-0.72)).
Conclusion: The protective effect of steroid treatment for severe COVID-19 reported in randomised clinical trials was replicated in this retrospective study of a large real-world cohort.
Keywords: COVID-19; Mortality; Retrospective cohort study; Steroids.