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Systemic Corticosteroids and Mortality in Severe and Critical COVID-19 Patients in Wuhan, China.

Authors
  • Wu, Jianfeng1
  • Huang, Jianqiang2
  • Zhu, Guochao3
  • Liu, Yihao4, 5
  • Xiao, Han6
  • Zhou, Qian4
  • Si, Xiang1
  • Yi, Hui2
  • Wang, Cuiping1
  • Yang, Daya7
  • Chen, Shuling6
  • Liu, Xin8
  • Liu, Zelong6
  • Wang, Qiongya9
  • Lv, Qingquan10
  • Huang, Ying11
  • Yu, Yang12
  • Guan, Xiangdong1
  • Li, Yanbing5
  • Nirantharakumar, Krishnarajah13, 14
  • And 3 more
  • 1 Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China. , (China)
  • 2 Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China. , (China)
  • 3 Department of Critical Care Medicine, The Affiliated Hospital of Jianghan University (No. Six Hospital of Wuhan), Wuhan, Hubei, People's Republic of China. , (China)
  • 4 Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China. , (China)
  • 5 Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China. , (China)
  • 6 Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China. , (China)
  • 7 Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China. , (China)
  • 8 Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China. , (China)
  • 9 Department of Critical Care Medicine, Wuhan Hankou Hospital, Wuhan, Hubei, People's Republic of China. , (China)
  • 10 Department of Gastrointestinal Surgery, Wuhan Hankou Hospital, Wuhan, Hubei, People's Republic of China. , (China)
  • 11 Science and Education Section, Wuhan Hankou Hospital, Wuhan, Hubei, People's Republic of China. , (China)
  • 12 Department of Gastrointestinal Surgery, The Affiliated Hospital of Jianghan University (No. Six Hospital of Wuhan), Wuhan, Hubei, People's Republic of China. , (China)
  • 13 Institute of Applied Health Research, University of Birmingham, United Kingdom. , (United Kingdom)
  • 14 Health Data Research UK, United Kingdom. , (United Kingdom)
  • 15 Precision Medicine Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China. , (China)
Type
Published Article
Journal
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Publication Date
Dec 01, 2020
Volume
105
Issue
12
Identifiers
DOI: 10.1210/clinem/dgaa627
PMID: 32880390
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Systemic corticosteroids are now recommended in many treatment guidelines, although supporting evidence is limited to 1 randomized controlled clinical trial (RECOVERY). To identify whether corticosteroids were beneficial to COVID-19 patients. A total of 1514 severe and 249 critical hospitalized COVID-19 patients from 2 medical centers in Wuhan, China. Multivariable Cox models, Cox model with time-varying exposure and propensity score analysis (inverse-probability-of-treatment-weighting [IPTW] and propensity score matching [PSM]) were used to estimate the association of corticosteroid use with risk of in-hospital mortality in severe and critical cases. Corticosteroids were administered in 531 (35.1%) severe and 159 (63.9%) critical patients. Compared to the non-corticosteroid group, systemic corticosteroid use was not associated with beneficial effect in reducing in-hospital mortality in either severe cases (HR = 1.77; 95% CI, 1.08-2.89; P = 0.023), or critical cases (HR = 2.07; 95% CI, 1.08-3.98; P = 0.028). Findings were similar in time-varying Cox analysis. For patients with severe COVID-19 at admission, corticosteroid use was not associated with improved or harmful outcome in either PSM or IPTW analysis. For critical COVID-19 patients at admission, results were consistent with multivariable Cox model analysis. Corticosteroid use was not associated with beneficial effect in reducing in-hospital mortality for severe or critical cases in Wuhan. Absence of the beneficial effect in our study in contrast to that observed in the RECOVERY clinical trial may be due to biases in observational data, in particular prescription by indication bias, differences in clinical characteristics of patients, choice of corticosteroid used, timing of initiation of treatment, and duration of treatment. © Endocrine Society 2020. All rights reserved. For permissions, please e-mail: [email protected]

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