Corticosteroids treatment in severe patients with COVID-19: a propensity score matching study

Abstract

Objectives: To explore the efficacy of corticosteroid treatment in patients with severe COVID-19 pneumonia and the association between corticosteroid use and patient mortality. Methods: A retrospective investigation was made on the medical records of the patients with severe and critical patients with COVID-19 pneumonia from January to February 2020. First, the patients who received corticosteroid treatment were compared with patients without given corticosteroid treatment. Then a propensity score matching method was used to control confounding factors. Cox survival regression analysis was used to evaluate the effect of corticosteroid therapy on the mortality of severe and critical patients with COVID-19. Results: A total of 371 severe and critical patients were included in our analyses. 209 patients were treated with corticosteroid therapy. Most of them were treated with methylprednisolone (197[94.3%]). The median corticosteroid therapy was applied 3(IQR 2-6) days after admission, 13(IQR 10-17) days after symptoms appeared. Temperature on admission(OR=1.255,[95%CI 1.021-1.547],p=0.032), ventilation(OR=1.926,[95%CI 1.148-3.269],p=0.014) and ICU admission(OR=3.713, [95%CI 1.776-8.277],p<0.001) were significantly associated with corticosteroids use. After PS matching, the cox regression survival analysis showed that corticosteroid use was significantly associated with a lower mortality rate (HR=0.592, [95%CI 0.406-0.862], p=0.006). Conclusion: Corticosteroid therapy use in severe and critical patients with COVID-19 pneumonia leads to lower mortality but may cause other side effects. Corticosteroid therapy should be used carefully.

Public Knowledge, Attitude, and Perception towards COVID-19 Vaccination in Saudi Arabia

“…Many interventions, such as corticosteroids and blood thinners, are being tried to minimize the complications of the disease [ 3 ]. Research is in progress in many centers to identify specific therapeutic agents that can effectively treat the infection [ 6 ]. Vaccination is suggested by WHO as the most suitable approach to build herd immunity in the population [ 1 , 4 ].…”

COVID-19 pneumonia in Galicia (Spain): Impact of prognostic factors and therapies on mortality and need for mechanical ventilation

“…The results of three meta-analysis further support the employ of systemic corticosteroids in COVID-19 pneumonia, but it is worth to mention that the weight of RECOVERY trial was more than 50 per cent in all of them and the magnitude of the effect was modest (OR ranging from 0.70 to 0.88) [ 41 – 43 ]. On the other hand, several propensity score matching (PSM) studies found no impact of corticosteroids on COVID-19 pneumonia outcome [ 44 – 49 ], while an increased mortality was observed in other report [ 50 ] and two additional PSM studies concluded that corticosteroid therapy was associated with lower mortality [ 51 , 52 ]. Therefore, considering all the available evidence, the role of corticosteroids remains controversial in non-critically ill patients who need supplemental oxygen.…”

Cost-effectiveness of the COVID-19 test, trace and isolate program in Colombia

“… 17 Hence, the maximum stay at moderate infection in the monitoring program was 17 days vs. 10 days in no intervention strategy. 18 Similarly, the maximum stay at severe infection was established in 21 days for no intervention and 15 days for the monitoring program due to the impact of the corticosteroids. 18 , 19 In total, an individual can be sick for up to 45 days, and then they recover or die.…”

“…It was assumed that recovered individuals return to their baseline utility (no long-term effects from COVID-19). Monitoring effectiveness was assumed to equal early corticosteroids treatment, [17] , [18] , [19] which is a conservative assumption given other benefits from early monitoring that are more difficult to quantify. The follow-up visits were assumed to last 15 minutes and a first primary care visit of 30 minutes.…”