Background The impact of corticosteroid therapy on outcomes of patients with coronavirus disease 2019 (COVID-19) is highly controversial. We aimed to compare the risk of death between COVID-19-related ARDS patients with corticosteroid treatment and those without. Methods In this single-center retrospective observational study, patients with ARDS caused by COVID-19 between January 20, 2020, and February 24, 2020, were enrolled. The primary outcome was 60-day in-hospital death. The exposure was prescribed systemic corticosteroids or not. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for 60-day in-hospital mortality. Results A total of 382 patients [60.7 ± 14.1 years old (mean ± SD), 61.3% males] were analyzed. The median of sequential organ failure assessment (SOFA) score was 2.0 (IQR 2.0–3.0). Of these cases, 94 (24.6%) patients had invasive mechanical ventilation. The number of patients received systemic corticosteroids was 226 (59.2%), and 156 (40.8%) received standard treatment. The maximum dose of corticosteroids was 80.0 (IQR 40.0–80.0) mg equivalent methylprednisolone per day, and duration of corticosteroid treatment was 7.0 (4.0–12.0) days in total. In Cox regression analysis using corticosteroid treatment as a time-varying variable, corticosteroid treatment was associated with a significant reduction in risk of in-hospital death within 60 days after adjusting for age, sex, SOFA score at hospital admission, propensity score of corticosteroid treatment, comorbidities, antiviral treatment, and respiratory supports (HR 0.42; 95% CI 0.21, 0.85; p = 0.0160). Corticosteroids were not associated with delayed viral RNA clearance in our cohort. Conclusion In this clinical practice setting, low-dose corticosteroid treatment was associated with reduced risk of in-hospital death within 60 days in COVID-19 patients who developed ARDS.
【저자키워드】 Methylprednisolone, severe acute respiratory syndrome coronavirus 2, Coronavirus disease 2019, Corticosteroids, Mortality, Propensity score, 【초록키워드】 Corticosteroid, COVID-19, Treatment, coronavirus disease, ARDS, Comorbidities, Sex, risk, Antiviral treatment, outcome, Cohort, Patient, age, SOFA, Hospital admission, in-hospital mortality, Clinical practice, retrospective, Invasive mechanical ventilation, dose, Respiratory Support, COVID-19 patient, Organ failure, SOFA score, In-hospital death, Cox regression model, risk of death, low-dose corticosteroid, Primary outcome, 95% CI, 95% confidence interval, reduced risk, standard treatment, hazard ratio, Cox regression analysis, single-center, corticosteroid therapy, corticosteroid treatment, viral RNA clearance, Result, enrolled, analyzed, caused, median, per day, were used, reduction in, ARDS patient, calculate, CIs, HRs, IQR, patients with ARDS, systemic corticosteroid, 【제목키워드】 coronavirus disease, therapy, cohort study, acute respiratory distress, propensity score analysis,