tetano
Editor, Senior Moderator
ERJ Open Res
. 2024 Sep 30;10(5):00474-2024.
doi: 10.1183/23120541.00474-2024. eCollection 2024 Sep. 1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study
Olivia C Leavy[SUP] 1 2 3 [/SUP], Richard J Russell[SUP] 2 3 [/SUP], Ewen M Harrison[SUP] 4 [/SUP], Nazir I Lone[SUP] 5 6 [/SUP], Steven Kerr[SUP] 4 7 [/SUP], Annemarie B Docherty[SUP] 4 [/SUP], Aziz Sheikh[SUP] 5 [/SUP], Matthew Richardson[SUP] 2 [/SUP], Omer Elneima[SUP] 2 [/SUP], Neil J Greening[SUP] 2 [/SUP], Victoria Claire Harris[SUP] 2 8 [/SUP], Linzy Houchen-Wolloff[SUP] 9 10 11 [/SUP], Hamish J C McAuley[SUP] 2 [/SUP], Ruth M Saunders[SUP] 2 [/SUP], Marco Sereno[SUP] 2 [/SUP], Aarti Shikotra[SUP] 12 [/SUP], Amisha Singapuri[SUP] 2 [/SUP], Raminder Aul[SUP] 13 [/SUP], Paul Beirne[SUP] 14 [/SUP], Charlotte E Bolton[SUP] 15 16 17 [/SUP], Jeremy S Brown[SUP] 18 [/SUP], Gourab Choudhury[SUP] 19 20 [/SUP], Nawar Diar Bakerly[SUP] 21 22 [/SUP], Nicholas Easom[SUP] 23 24 [/SUP], Carlos Echevarria[SUP] 25 26 [/SUP], Jonathan Fuld[SUP] 27 28 29 [/SUP], Nick Hart[SUP] 30 [/SUP], John R Hurst[SUP] 31 32 [/SUP], Mark Jones[SUP] 33 34 [/SUP], Dhruv Parekh[SUP] 35 36 [/SUP], Paul Pfeffer[SUP] 37 38 [/SUP], Najib M Rahman[SUP] 39 40 41 42 [/SUP], Sarah Rowland-Jones[SUP] 43 44 [/SUP], Ajay M Shah[SUP] 45 46 [/SUP], Dan G Wootton[SUP] 47 48 49 [/SUP], Caroline Jolley[SUP] 45 46 [/SUP], A A Roger Thompson[SUP] 43 44 [/SUP], Trudie Chalder[SUP] 50 51 [/SUP], Melanie J Davies[SUP] 8 12 52 [/SUP], Anthony De Soyza[SUP] 53 54 [/SUP], John R Geddes[SUP] 55 56 [/SUP], William Greenhalf[SUP] 48 57 58 [/SUP], Simon Heller[SUP] 59 [/SUP], Luke Howard[SUP] 60 61 [/SUP], Joseph Jacob[SUP] 62 63 [/SUP], R Gisli Jenkins[SUP] 64 [/SUP], Janet M Lord[SUP] 65 66 [/SUP], Will D-C Man[SUP] 67 68 [/SUP], Gerry P McCann[SUP] 12 69 [/SUP], Stefan Neubauer[SUP] 55 70 [/SUP], Peter J M Openshaw[SUP] 64 [/SUP], Joanna Porter[SUP] 18 71 [/SUP], Matthew J Rowland[SUP] 72 [/SUP], Janet T Scott[SUP] 73 [/SUP], Malcolm G Semple[SUP] 74 75 [/SUP], Sally J Singh[SUP] 2 [/SUP], David Thomas[SUP] 61 [/SUP], Mark Toshner[SUP] 29 76 [/SUP], Keir Lewis[SUP] 77 78 79 [/SUP], Liam G Heaney[SUP] 80 81 [/SUP], Andrew Briggs[SUP] 82 [/SUP], Bang Zheng[SUP] 82 [/SUP], Mathew Thorpe[SUP] 4 [/SUP], Jennifer K Quint[SUP] 68 [/SUP], James D Chalmers[SUP] 83 [/SUP], Ling-Pei Ho[SUP] 41 84 [/SUP], Alex Horsley[SUP] 85 86 [/SUP], Michael Marks[SUP] 87 88 89 [/SUP], Krisnah Poinasamy[SUP] 90 [/SUP], Betty Raman[SUP] 39 91 [/SUP], Louise V Wain[SUP] 1 2 [/SUP], Christopher E Brightling[SUP] 2 [/SUP], Rachael A Evans[SUP] 2 8 [/SUP]
Affiliations
Background: In patients with coronavirus disease 2019 (COVID-19) requiring supplemental oxygen, dexamethasone reduces acute severity and improves survival, but longer-term effects are unknown. We hypothesised that systemic corticosteroid administration during acute COVID-19 would be associated with improved health-related quality of life (HRQoL) 1 year after discharge.
Methods: Adults admitted to hospital between February 2020 and March 2021 for COVID-19 and meeting current guideline recommendations for dexamethasone treatment were included using two prospective UK cohort studies (Post-hospitalisation COVID-19 and the International Severe Acute Respiratory and emerging Infection Consortium). HRQoL, assessed by the EuroQol-Five Dimensions-Five Levels utility index (EQ-5D-5L UI), pre-hospital and 1 year after discharge were compared between those receiving corticosteroids or not after propensity weighting for treatment. Secondary outcomes included patient-reported recovery, physical and mental health status, and measures of organ impairment. Sensitivity analyses were undertaken to account for survival and selection bias.
Findings: Of the 1888 participants included in the primary analysis, 1149 received corticosteroids. There was no between-group difference in EQ-5D-5L UI at 1 year (mean difference 0.004, 95% CI -0.026-0.034). A similar reduction in EQ-5D-5L UI was seen at 1 year between corticosteroid exposed and nonexposed groups (mean±sd change -0.12±0.22 versus -0.11±0.22). Overall, there were no differences in secondary outcome measures. After sensitivity analyses modelled using a cohort of 109 318 patients admitted to hospital with COVID-19, EQ-5D-5L UI at 1 year remained similar between the two groups.
Interpretation: Systemic corticosteroids for acute COVID-19 have no impact on the large reduction in HRQoL 1 year after hospital discharge. Treatments to address the persistent reduction in HRQoL are urgently needed.
. 2024 Sep 30;10(5):00474-2024.
doi: 10.1183/23120541.00474-2024. eCollection 2024 Sep. 1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study
Olivia C Leavy[SUP] 1 2 3 [/SUP], Richard J Russell[SUP] 2 3 [/SUP], Ewen M Harrison[SUP] 4 [/SUP], Nazir I Lone[SUP] 5 6 [/SUP], Steven Kerr[SUP] 4 7 [/SUP], Annemarie B Docherty[SUP] 4 [/SUP], Aziz Sheikh[SUP] 5 [/SUP], Matthew Richardson[SUP] 2 [/SUP], Omer Elneima[SUP] 2 [/SUP], Neil J Greening[SUP] 2 [/SUP], Victoria Claire Harris[SUP] 2 8 [/SUP], Linzy Houchen-Wolloff[SUP] 9 10 11 [/SUP], Hamish J C McAuley[SUP] 2 [/SUP], Ruth M Saunders[SUP] 2 [/SUP], Marco Sereno[SUP] 2 [/SUP], Aarti Shikotra[SUP] 12 [/SUP], Amisha Singapuri[SUP] 2 [/SUP], Raminder Aul[SUP] 13 [/SUP], Paul Beirne[SUP] 14 [/SUP], Charlotte E Bolton[SUP] 15 16 17 [/SUP], Jeremy S Brown[SUP] 18 [/SUP], Gourab Choudhury[SUP] 19 20 [/SUP], Nawar Diar Bakerly[SUP] 21 22 [/SUP], Nicholas Easom[SUP] 23 24 [/SUP], Carlos Echevarria[SUP] 25 26 [/SUP], Jonathan Fuld[SUP] 27 28 29 [/SUP], Nick Hart[SUP] 30 [/SUP], John R Hurst[SUP] 31 32 [/SUP], Mark Jones[SUP] 33 34 [/SUP], Dhruv Parekh[SUP] 35 36 [/SUP], Paul Pfeffer[SUP] 37 38 [/SUP], Najib M Rahman[SUP] 39 40 41 42 [/SUP], Sarah Rowland-Jones[SUP] 43 44 [/SUP], Ajay M Shah[SUP] 45 46 [/SUP], Dan G Wootton[SUP] 47 48 49 [/SUP], Caroline Jolley[SUP] 45 46 [/SUP], A A Roger Thompson[SUP] 43 44 [/SUP], Trudie Chalder[SUP] 50 51 [/SUP], Melanie J Davies[SUP] 8 12 52 [/SUP], Anthony De Soyza[SUP] 53 54 [/SUP], John R Geddes[SUP] 55 56 [/SUP], William Greenhalf[SUP] 48 57 58 [/SUP], Simon Heller[SUP] 59 [/SUP], Luke Howard[SUP] 60 61 [/SUP], Joseph Jacob[SUP] 62 63 [/SUP], R Gisli Jenkins[SUP] 64 [/SUP], Janet M Lord[SUP] 65 66 [/SUP], Will D-C Man[SUP] 67 68 [/SUP], Gerry P McCann[SUP] 12 69 [/SUP], Stefan Neubauer[SUP] 55 70 [/SUP], Peter J M Openshaw[SUP] 64 [/SUP], Joanna Porter[SUP] 18 71 [/SUP], Matthew J Rowland[SUP] 72 [/SUP], Janet T Scott[SUP] 73 [/SUP], Malcolm G Semple[SUP] 74 75 [/SUP], Sally J Singh[SUP] 2 [/SUP], David Thomas[SUP] 61 [/SUP], Mark Toshner[SUP] 29 76 [/SUP], Keir Lewis[SUP] 77 78 79 [/SUP], Liam G Heaney[SUP] 80 81 [/SUP], Andrew Briggs[SUP] 82 [/SUP], Bang Zheng[SUP] 82 [/SUP], Mathew Thorpe[SUP] 4 [/SUP], Jennifer K Quint[SUP] 68 [/SUP], James D Chalmers[SUP] 83 [/SUP], Ling-Pei Ho[SUP] 41 84 [/SUP], Alex Horsley[SUP] 85 86 [/SUP], Michael Marks[SUP] 87 88 89 [/SUP], Krisnah Poinasamy[SUP] 90 [/SUP], Betty Raman[SUP] 39 91 [/SUP], Louise V Wain[SUP] 1 2 [/SUP], Christopher E Brightling[SUP] 2 [/SUP], Rachael A Evans[SUP] 2 8 [/SUP]
Affiliations
- PMID: 39351379
- PMCID: PMC11440406
- DOI: 10.1183/23120541.00474-2024
Background: In patients with coronavirus disease 2019 (COVID-19) requiring supplemental oxygen, dexamethasone reduces acute severity and improves survival, but longer-term effects are unknown. We hypothesised that systemic corticosteroid administration during acute COVID-19 would be associated with improved health-related quality of life (HRQoL) 1 year after discharge.
Methods: Adults admitted to hospital between February 2020 and March 2021 for COVID-19 and meeting current guideline recommendations for dexamethasone treatment were included using two prospective UK cohort studies (Post-hospitalisation COVID-19 and the International Severe Acute Respiratory and emerging Infection Consortium). HRQoL, assessed by the EuroQol-Five Dimensions-Five Levels utility index (EQ-5D-5L UI), pre-hospital and 1 year after discharge were compared between those receiving corticosteroids or not after propensity weighting for treatment. Secondary outcomes included patient-reported recovery, physical and mental health status, and measures of organ impairment. Sensitivity analyses were undertaken to account for survival and selection bias.
Findings: Of the 1888 participants included in the primary analysis, 1149 received corticosteroids. There was no between-group difference in EQ-5D-5L UI at 1 year (mean difference 0.004, 95% CI -0.026-0.034). A similar reduction in EQ-5D-5L UI was seen at 1 year between corticosteroid exposed and nonexposed groups (mean±sd change -0.12±0.22 versus -0.11±0.22). Overall, there were no differences in secondary outcome measures. After sensitivity analyses modelled using a cohort of 109 318 patients admitted to hospital with COVID-19, EQ-5D-5L UI at 1 year remained similar between the two groups.
Interpretation: Systemic corticosteroids for acute COVID-19 have no impact on the large reduction in HRQoL 1 year after hospital discharge. Treatments to address the persistent reduction in HRQoL are urgently needed.