Objective: This study aims to compare all-cause mortality and other hospital outcomes of hospitalized coronavirus disease of 2019 patients using corticosteroids. Materials and methods: A comparative cross-sectional study was performed over three months by collecting data from patients' medical charts. Results: The sample included 129 patients with type 2 diabetes (T2D) and 293 patients without diabetes, with more men than women in both groups. Patients with T2D were older, namely, those aged more than 70 years (54.3%) with the majority having abnormal glucose levels on admission (76.1%) and at discharge (76.9%). As a primary outcome, higher all-cause mortality was reported among patients without diabetes having more than two comorbidities (38.2%) compared to those with two or single comorbidities (21.0% and 13.9% respectively; p = 0.009). It significantly increased if patients without diabetes had abnormal glucose levels at admission (51.7%; p < 0.001) and discharge (44.7%; p < 0.001) compared to those with normal levels. Critical cases had higher all-cause mortality compared to less severe cases in patients with T2D (58.8%; p < 0.001) and without diabetes (61.0%; p < 0.001). Among secondary outcomes, a higher length of stay in the hospital was noted among patients with T2D (8.4 vs. 7.3 days; p = 0.015), in addition to a significantly higher number of ventilator-free days (2.7 vs. 1.6 days; p = 0.039). Conclusions: Although the treatment with corticosteroids was comparable between patients with and without T2D, hospital outcomes varied between the groups. Findings from this study can help provide additional clinical support for patients with T2D to allow better in-hospital management of COVID-19 cases.
Introduction: Despite the recommendations to avoid using corticosteroids systematically for hospitalized coronavirus disease of 2019 (COVID-19) patients, healthcare professionals used personalized treatments, including corticosteroids, as adjuncts to treat their patients due to their limited access to treatment options. This study aims to evaluate the use of corticosteroids among hospitalized COVID-19 patients with all-cause mortality as the primary outcome and to assess the predictors of all-cause mortality associated with the characteristics of the patients and the corticosteroid regimens adopted. Methods: A multicenter retrospective study was performed over three months targeting 422 COVID-19 patients from six hospitals in Lebanon. Data were collected from patients’ medical charts retrospectively and covered a period of one year (September 2020–August 2021). Results: The study sample included 422 patients, predominantly males, with 59% of cases classified as severe or critical cases. Dexamethasone and methylprednisolone were the most used corticosteroids. Around 22% of the patients died during hospitalization. After adjusting for covariates, performing a polymerase chain reaction before admission increased the mortality rate by 424% compared to doing it at hospital admission (aHR 4.24, 95% CI 1.35–13.3), with 18.11 times higher mortality rate among critical cases (aHR 18.11, 95% CI 9.63–31.05). Exposure to side effects from corticosteroids increased the mortality rate by 514% compared to others (aHR 5.14, 95% CI 1.28–8.58). In particular, the mortality rate among patients having hyperglycemia dropped by 73% compared to others (aHR 0.27, 95% CI 0.06–0.98). Conclusion: Corticosteroids are frequently used in treating hospitalized COVID-19 patients. The all-cause mortality rate was higher among older and critical cases and lower among smokers and those treated for more than 7 days. Research exploring the safety and efficacy of corticosteroids is required to allow better in-hospital management of COVID-19 cases.
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