Abstract
Objectives
Corticosteroids were clinically used in the treatment of nonsevere patients with COVID-19, but the efficacy of such treatment lacked sufficient clinical evidence, and the impact of dose had never been studied. This study aimed to evaluate the effect of systemic corticosteroid use (SCU) in nonsevere patients with COVID-19.
Methods
We conducted a multicenter retrospective cohort study in Hubei Province. A total of 1726 patients admitted with nonsevere type COVID-19 were included. Mixed-effect Cox model, mixed-effect Cox model with time-varying exposure, multiple linear regression, and propensity score analysis (inverse probability of treatment weight and propensity score matching) were used to explore the association between SCU and progression into severe type, all-cause mortality, and length of stay.
Results
During the follow-up of 30 days, 29.8% of nonsevere patients with COVID-19 received treatment with systemic corticosteroids. The use of systemic corticosteroids was associated with higher probability of developing severe type (adjusted hazard ratio 1.81; 95% confidence interval 1.47-2.21), all-cause mortality (adjusted hazard ratio 2.92; 95% confidence interval 1.39-6.15) in time-varying Cox analysis, and prolonged hospitalization (β 4.14; P < .001) in multiple linear regression. Analysis with 2 propensity score cohorts displayed similar results. Besides, increased corticosteroid dose was significantly associated with elevated probability of developing severe type (P < .001) and prolonged hospitalization (P < .001).
Conclusions
Corticosteroid treatment against nonsevere patients with COVID-19 was significantly associated with worse clinical outcomes. The higher dose was significantly associated with elevated risk of poor disease progression. We recommend that SCU should be avoided unless necessary among nonsevere patients with COVID-19.
【저자키워드】 COVID-19, Corticosteroids, Mortality, outcomes, 【초록키워드】 Corticosteroid, Treatment, Efficacy, Hospitalization, risk, progression, clinical outcomes, Probability, Disease progression, Cohort, Patient, Follow-up, multicenter, association, Analysis, dose, propensity score matching, Multiple linear regression, retrospective cohort study, 95% confidence interval, adjusted hazard ratio, systemic corticosteroids, all-cause mortality, clinical evidence, propensity score analysis, objective, Cox model, Result, significantly, clinically, elevated, conducted, were used, evaluate the effect, patients with COVID-19, SCU, systemic corticosteroid, 【제목키워드】 longitudinal, systemic,