Abstract
Background: Glucocorticoids are one of the current standard agents for moderate to severe coronavirus disease 2019 (COVID-19) treatment based on the RECOVERY trial. Data on the real clinical application of steroids for COVID-19 are scarce and will help guide the optimal use of steroids. We described the current prescription pattern of steroids for COVID-19 and investigated the factors related to specific practices.
Methods: All adults aged ≥ 19 years who were diagnosed with COVID-19 by real-time reverse transcription-polymerase chain reaction and admitted to one of 3 study hospitals from 8 December 2020 to 30 June 2021 were enrolled. Demographic and clinical data, including medications and oxygen therapy, were retrospectively collected from electronic medical records. The severity of comorbidities and COVID-19 were measured. The subjects were divided into steroid and nonsteroid groups, and the steroid group was then subdivided into standard and higher/longer groups.
Results: Among a total of 805 patients, 217 (27.0%) were treated with steroids. The steroid group showed a higher rate of oxygen therapy (81.1% vs. 2.7%), more concomitant use of remdesivir (77.4% vs. 1.4%) or antibiotics (79.3% vs. 4.3%), and a higher proportion of high risk according to National Early Warning Score-2 score (30.0% vs. 0.9%) or severe risk according to National Institute of Allergy and Infectious Disease Ordinal Scale score (81.1% vs. 2.7%) than the nonsteroid group. The mortality of the steroid group was 4.6%. In the steroid group, 82.5% received a standard or lower dose of steroids within ten days, and 17.5% (38/217) received a higher or longer dose of steroids. Multivariate analysis showed that initial lymphopenia (adjusted odds ratio [aOR], 0.94; 95% confidence interval [CI], 0.89-0.99) and high level of lactate dehydrogenase (LDH) (aOR, 1.00; 95% CI, 1.00-1.01) were independent risk factors for higher doses or longer steroid use.
Conclusion: The dose and duration of steroids were in line with current guidelines in 82.5% of COVID-19 patients, but the outliers may need tailored therapy according to surrogate markers, such as initial lymphopenia or high level of LDH.
Keywords: COVID-19; SARS-CoV-2; Steroid.
【저자키워드】 COVID-19, SARS-CoV-2, Steroid., 【초록키워드】 Treatment, coronavirus disease, Glucocorticoids, Coronavirus disease 2019, therapy, Mortality, severity, hospital, Comorbidities, Remdesivir, LDH, Comorbidity, risk, oxygen, Antibiotics, Infectious disease, medications, lactate dehydrogenase, Steroids, lymphopenia, polymerase chain reaction, Oxygen therapy, allergy, scale, electronic medical records, medication, demographic, moderate, patients, RECOVERY trial, COVID-19 patients, Reverse transcription-polymerase chain reaction, Multivariate analysis, Ordinal Scale, Lactate, dose, steroid, high risk, Chain Reaction, moderate to severe, surrogate markers, steroid use, Factor, adjusted odds ratio, 95% CI, 95% confidence interval, Clinical data, severe coronavirus disease, subject, independent risk factors, help, real-time reverse transcription-polymerase chain reaction, Demographic and clinical data, independent risk factor, concomitant use, lower dose, outliers, outlier, initial, enrolled, described, collected, proportion, investigated, treated, groups, were measured, diagnosed with COVID-19, use of steroids, 【제목키워드】 omicron, clinical,