tetano
Editor, Senior Moderator
Korean J Intern Med
. 2023 Apr 11.
doi: 10.3904/kjim.2022.201. Online ahead of print.
Corticosteroid outcome may be dependent of duration of use in severe COVID-19
Jin Hyoung Kim[SUP] 1 [/SUP], Yong Sub Na[SUP] 2 [/SUP], Song-I Lee[SUP] 3 [/SUP], Youn Young Moon[SUP] 4 [/SUP], Beom Seuk Hwang[SUP] 4 [/SUP], Ae-Rin Baek[SUP] 5 [/SUP], Won-Young Kim[SUP] 6 [/SUP], Bo Young Lee[SUP] 7 [/SUP], Gil Myeong Seong[SUP] 8 [/SUP], Moon Seong Baek[SUP] 6 [/SUP]
Affiliations
Abstract
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).
Conclusions: 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.
Keywords: COVID-19; Mortality; Oxygen inhalation therapy; Respiration, Artificial; Steroids.
. 2023 Apr 11.
doi: 10.3904/kjim.2022.201. Online ahead of print.
Corticosteroid outcome may be dependent of duration of use in severe COVID-19
Jin Hyoung Kim[SUP] 1 [/SUP], Yong Sub Na[SUP] 2 [/SUP], Song-I Lee[SUP] 3 [/SUP], Youn Young Moon[SUP] 4 [/SUP], Beom Seuk Hwang[SUP] 4 [/SUP], Ae-Rin Baek[SUP] 5 [/SUP], Won-Young Kim[SUP] 6 [/SUP], Bo Young Lee[SUP] 7 [/SUP], Gil Myeong Seong[SUP] 8 [/SUP], Moon Seong Baek[SUP] 6 [/SUP]
Affiliations
- PMID: 37038264
- DOI: 10.3904/kjim.2022.201
Abstract
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).
Conclusions: 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.
Keywords: COVID-19; Mortality; Oxygen inhalation therapy; Respiration, Artificial; Steroids.