Systemic Corticosteroids and Mortality in Severe and Critical COVID-19 Patients in Wuhan, China

Author:

Wu Jianfeng1,Huang Jianqiang2,Zhu Guochao3,Liu Yihao45,Xiao Han6,Zhou Qian4,Si Xiang1,Yi Hui2,Wang Cuiping1,Yang Daya7,Chen Shuling6,Liu Xin8,Liu Zelong6,Wang Qiongya9,Lv Qingquan10,Huang Ying11,Yu Yang12,Guan Xiangdong1,Li Yanbing5ORCID,Nirantharakumar Krishnarajah1314,Cheng KarKeung13,Peng Sui4,Xiao Haipeng515ORCID

Affiliation:

1. Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China

2. Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China

3. Department of Critical Care Medicine, The Affiliated Hospital of Jianghan University (No. Six Hospital of Wuhan), Wuhan, Hubei, People’s Republic of China

4. Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China

5. Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China

6. Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China

7. Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China

8. Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China

9. Department of Critical Care Medicine, Wuhan Hankou Hospital, Wuhan, Hubei, People’s Republic of China

10. Department of Gastrointestinal Surgery, Wuhan Hankou Hospital, Wuhan, Hubei, People’s Republic of China

11. Science and Education Section, Wuhan Hankou Hospital, Wuhan, Hubei, People’s Republic of China

12. Department of Gastrointestinal Surgery, The Affiliated Hospital of Jianghan University (No. Six Hospital of Wuhan), Wuhan, Hubei, People’s Republic of China

13. Institute of Applied Health Research, University of Birmingham, United Kingdom

14. Health Data Research UK, United Kingdom

15. Precision Medicine Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China

Abstract

Abstract Background Systemic corticosteroids are now recommended in many treatment guidelines, although supporting evidence is limited to 1 randomized controlled clinical trial (RECOVERY). Objective To identify whether corticosteroids were beneficial to COVID-19 patients. Methods A total of 1514 severe and 249 critical hospitalized COVID-19 patients from 2 medical centers in Wuhan, China. Multivariable Cox models, Cox model with time-varying exposure and propensity score analysis (inverse-probability-of-treatment-weighting [IPTW] and propensity score matching [PSM]) were used to estimate the association of corticosteroid use with risk of in-hospital mortality in severe and critical cases. Results Corticosteroids were administered in 531 (35.1%) severe and 159 (63.9%) critical patients. Compared to the non-corticosteroid group, systemic corticosteroid use was not associated with beneficial effect in reducing in-hospital mortality in either severe cases (HR = 1.77; 95% CI, 1.08-2.89; P = 0.023), or critical cases (HR = 2.07; 95% CI, 1.08–3.98; P = 0.028). Findings were similar in time-varying Cox analysis. For patients with severe COVID-19 at admission, corticosteroid use was not associated with improved or harmful outcome in either PSM or IPTW analysis. For critical COVID-19 patients at admission, results were consistent with multivariable Cox model analysis. Conclusion Corticosteroid use was not associated with beneficial effect in reducing in-hospital mortality for severe or critical cases in Wuhan. Absence of the beneficial effect in our study in contrast to that observed in the RECOVERY clinical trial may be due to biases in observational data, in particular prescription by indication bias, differences in clinical characteristics of patients, choice of corticosteroid used, timing of initiation of treatment, and duration of treatment.

Publisher

The Endocrine Society

Subject

Biochemistry (medical),Clinical Biochemistry,Endocrinology,Biochemistry,Endocrinology, Diabetes and Metabolism

Reference37 articles.

1. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study;Zhou;Lancet.,2020

2. [An update on the epidemiological characteristics of novel coronavirus pneumoniaCOVID-19];Special Expert Group for Control of the Epidemic of Novel Coronavirus Pneumonia of the Chinese Preventive Medicine Association;Zhonghua Liu Xing Bing Xue Za Zhi,2020

3. Corticosteroid therapy for critically ill patients with middle east respiratory syndrome;Arabi;Am J Respir Crit Care Med.,2018

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