Abstract
Introduction: Randomised controlled trials have shown that steroids reduce the risk of dying in patients with severe Coronavirus disease 2019 (COVID-19), whilst many real-world studies have failed to replicate this result. We aim to investigate real-world effectiveness of steroids in severe COVID-19.
Methods: Clinical, demographic, and viral genome data extracted from electronic patient record (EPR) was analysed from all SARS-CoV-2 RNA positive patients admitted with severe COVID-19, defined by hypoxia at presentation, between March 13th 2020 and May 27th 2021. Steroid treatment was measured by the number of prescription-days with dexamethasone, hydrocortisone, prednisolone or methylprednisolone. The association between steroid > 3 days treatment and disease outcome was explored using multivariable cox proportional hazards models with adjustment for confounders (including age, gender, ethnicity, co-morbidities and SARS-CoV-2 variant). The outcome was in-hospital mortality.
Results: 1100 severe COVID-19 cases were identified having crude hospital mortality of 15.3%. 793/1100 (72.1%) individuals were treated with steroids and 513/1100 (46.6%) received steroid ≤ 3 days. From the multivariate model, steroid > 3 days was associated with decreased hazard of in-hospital mortality (HR: 0.47 (95% CI: 0.31-0.72)).
Conclusion: The protective effect of steroid treatment for severe COVID-19 reported in randomised clinical trials was replicated in this retrospective study of a large real-world cohort.
Keywords: COVID-19; Mortality; Retrospective cohort study; Steroids.
【저자키워드】 COVID-19, Mortality, Steroids, retrospective cohort study, 【초록키워드】 Dexamethasone, Methylprednisolone, Treatment, Coronavirus disease 2019, severe COVID-19, hypoxia, hospital, SARS-CoV-2 variant, Gender, risk, outcome, Retrospective study, Cohort, clinical, Patient, Effectiveness, Controlled trial, co-morbidity, age, Hydrocortisone, SARS-CoV-2 RNA, disease, in-hospital mortality, protective effect, randomised clinical trial, association, viral genome, steroid, Prednisolone, individual, hazard, multivariate model, confounder, steroid treatment, multivariable, EPR, was measured, defined, shown, reported, replicate, analysed, treated, reduce, replicated, positive patient, 【제목키워드】 Effectiveness, steroid,