Abstract
Objective: To assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19).
Methods: A multicentre observational study was performed from 22 February through 30 June 2020. We included consecutive adult patients with severe COVID-19, defined as respiratory rate ≥30 breath per minute, oxygen saturation ≤93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ≤300 mm Hg. We excluded patients being treated with other immunomodulant drugs, receiving low-dose corticosteroids and receiving corticosteroids 72 hours after admission. The primary endpoint was 30-day mortality from hospital admission. The main exposure variable was corticosteroid therapy at a dose of ≥0.5 mg/kg of prednisone equivalents. It was introduced as binomial covariate in a logistic regression model for the primary endpoint and inverse probability of treatment weighting using the propensity score.
Results: Of 1717 patients with COVID-19 evaluated, 513 were included in the study, and of these, 170 (33%) were treated with corticosteroids. During hospitalization, 166 patients (34%) met the criteria of the primary outcome (60/170, 35% in the corticosteroid group and 106/343, 31% in the noncorticosteroid group). At multivariable analysis corticosteroid treatment was not associated with lower 30-day mortality rate (adjusted odds ratio, 0.59; 95% confidence interval (CI), 0.20-1.74; p 0.33). After inverse probability of treatment weighting, corticosteroids were not associated with lower 30-day mortality (average treatment effect, 0.05; 95% CI, -0.02 to 0.09; p 0.12). However, subgroup analysis revealed that in patients with PO2/FiO2 < 200 mm Hg at admission (135 patients, 52 (38%) treated with corticosteroids), corticosteroid treatment was associated with a lower risk of 30-day mortality (23/52, 44% vs. 45/83, 54%; adjusted odds ratio, 0.20; 95% CI, 0.04-0.90; p 0.036).
Conclusions: The effect of corticosteroid treatment on mortality might be limited to critically ill COVID-19 patients.
Keywords: ARDS; COVID-19; Corticosteroids; Mortality; SARS-CoV-2.
【저자키워드】 COVID-19, SARS-CoV-2, ARDS, Corticosteroids, Mortality, 【초록키워드】 Corticosteroid, Treatment, coronavirus disease, SARS-CoV-2, Coronavirus disease 2019, Efficacy, ARDS, Corticosteroids, severe COVID-19, Hospitalization, drugs, oxygen, observational study, Probability, oxygen saturation, Critically ill, low-dose, breath, Patient, Prednisone, multicentre, Hospital admission, Admission, patients, COVID-19 patients, 30-Day mortality, Propensity score, primary endpoint, dose, respiratory rate, critically ill COVID-19 patients, criteria, partial pressure, corticosteroids), arterial partial pressure of oxygen, adjusted odds ratio, low-dose corticosteroid, Primary outcome, FiO2, 95% CI, 95% confidence interval, minute, logistic regression model, average, multivariable analysis, lower risk, fraction, covariate, subgroup analysis, corticosteroid therapy, corticosteroid treatment, binomial, ambient, Weighting, low-dose corticosteroids, 30-day mortality rate, defined, evaluated, receiving, was performed, treated, introduced, excluded, patients with COVID-19, the primary endpoint, 【제목키워드】 Corticosteroid, multicentre, hospitalized patient,