Corticosteroid Therapy in COVID-19 Associated With In-hospital Mortality in Geriatric Patients: A Propensity Matched Cohort Study-Reference-Cited by-同舟云学术

Corticosteroid Therapy in COVID-19 Associated With In-hospital Mortality in Geriatric Patients: A Propensity Matched Cohort Study

Published:2022-04-08 Issue:7 Volume:77 Page:1352-1360
ISSN:1079-5006
Container-title:The Journals of Gerontology: Series A
language:en
Short-container-title:

Author:

Lidou-Renault Valentine¹,Baudouin Edouard²³,Courtois-Amiot Pauline⁴,Bianco Celine¹,Esnault Hélène⁴,Rouet Audrey⁵,Baque Margaux¹⁶,Tomeo Charlotte⁷,Rainone Antonio⁸,Thietart Sara⁹,Veber Romain⁷,Ayache Clementine⁷,Pepin Marion¹⁰¹¹^ORCID,Lafuente-Lafuente Carmelo⁸,Duron Emmanuelle²³^ORCID,Cailleaux Pierre-Emmanuel¹²^ORCID,Haguenauer Didier¹²,Lemarié Nadège⁵,Paillaud Elena¹³,Raynaud-Simon Agathe⁴,Thomas Caroline¹,Boddaert Jacques⁶⁹,Zerah Lorène⁹¹⁴,Vallet Hélène¹⁶^ORCID

Affiliation:

1. Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Saint Antoine, Department of Geriatric Medicine , Paris , France

2. Assistance Publique-Hôpitaux de Paris (APHP), University hospital of Paris-Saclay, Department of Geriatric Medicine, Paul Brousse Hospital , Villejuif , France

3. Université Paris-Saclay, INSERM 1178, CESP, Équipe MOODS , Le Kremlin-Bicêtre , France

4. Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, Hôpital Bichat, Department of Geriatric Medicine , Paris , France

5. Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Tenon, Department of Geriatric Medicine , Paris , France

6. Sorbonne Université, INSERM UMR1135, Centre d’immunologie et des Maladies Infectieuses , Paris , France

7. Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Rothschild, Department of Geriatric Medicine , Paris , France

8. Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Charles Foix, Department of Geriatric Medicine , Ivry Sur Seine , France

9. Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Pitié Salpêtrière, Department of Geriatric Medicine , Paris , France

10. Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Ambroise Paré, Department of Geriatric Medicine , Boulogne, Billancourt, France

11. Université de Versailles Saint-Quentin en Yvelines, Université Paris-Saclay, INSERM, CESP, Clinical Epidemiology , Villejuif , France

12. Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Department of Geriatric Medicine , Colombes , France

13. Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, Paris Cancer Institute CARPEM, Department of Geriatric Medicine, Hôpital Européen Georges Pompidou , Paris , France

14. Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, IPLESP , Paris , France

Abstract

Abstract Background Few data are available on the prognosis of older patients who received corticosteroids for COVID-19. We aimed to compare the in-hospital mortality of geriatric patients hospitalized for COVID-19 who received corticosteroids or not. Methods We conducted a multicentric retrospective cohort study in 15 acute COVID-19 geriatric wards in the Paris area from March to April 2020 and November 2020 to May 2021. We included all consecutive patients aged 70 years and older who were hospitalized with confirmed COVID-19 in these wards. Propensity score and multivariate analyses were used. Results Of the 1 579 patients included (535 received corticosteroids), the median age was 86 (interquartile range 81–91) years, 56% of patients were female, the median Charlson Comorbidity Index (CCI) was 2.6 (interquartile range 1–4), and 64% of patients were frail (Clinical Frailty Score 5–9). The propensity score analysis paired 984 patients (492 with and without corticosteroids). The in-hospital mortality was 32.3% in the matched cohort. On multivariate analysis, the probability of in-hospital mortality was increased with corticosteroid use (odds ratio [OR] = 2.61 [95% confidence interval (CI) 1.63–4.20]). Other factors associated with in-hospital mortality were age (OR = 1.04 [1.01–1.07], CCI (OR = 1.18 [1.07–1.29], activities of daily living (OR = 0.85 [0.75–0.95], oxygen saturation < 90% on room air (OR = 2.15 [1.45–3.17], C-reactive protein level (OR = 2.06 [1.69–2.51], and lowest lymphocyte count (OR = 0.49 [0.38–0.63]). Among the 535 patients who received corticosteroids, 68.3% had at least one corticosteroid side effect, including delirium (32.9%), secondary infections (32.7%), and decompensated diabetes (14.4%). Conclusions In this multicentric matched-cohort study of geriatric patients hospitalized for COVID-19, the use of corticosteroids was significantly associated with in-hospital mortality.

Publisher

Oxford University Press (OUP)

Subject

Geriatrics and Gerontology,Aging

Link

https://academic.oup.com/biomedgerontology/advance-article-pdf/doi/10.1093/gerona/glac084/43722062/glac084.pdf

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