Real-world effectiveness of steroids in severe COVID-19: a retrospective cohort study
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...
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| Format: | Article |
| Language: | English |
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BMC
2022-10-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-022-07750-3 |
| _version_ | 1817979606457647104 |
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| author | Wenjuan Wang Luke B Snell Davide Ferrari Anna L Goodman Nicholas M Price Charles D Wolfe Vasa Curcin Jonathan D Edgeworth Yanzhong Wang |
| author_facet | Wenjuan Wang Luke B Snell Davide Ferrari Anna L Goodman Nicholas M Price Charles D Wolfe Vasa Curcin Jonathan D Edgeworth Yanzhong Wang |
| author_sort | Wenjuan Wang |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T22:44:45Z |
| format | Article |
| id | doaj.art-8dda7d566c344eda87fd1ba8ba4e2aa5 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-13T22:44:45Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-8dda7d566c344eda87fd1ba8ba4e2aa52022-12-22T02:26:28ZengBMCBMC Infectious Diseases1471-23342022-10-012211710.1186/s12879-022-07750-3Real-world effectiveness of steroids in severe COVID-19: a retrospective cohort studyWenjuan Wang0Luke B Snell1Davide Ferrari2Anna L Goodman3Nicholas M Price4Charles D Wolfe5Vasa Curcin6Jonathan D Edgeworth7Yanzhong Wang8School of Population Health and Environmental Sciences, King’s College LondonCentre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College LondonSchool of Population Health and Environmental Sciences, King’s College LondonDepartment of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation TrustDepartment of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation TrustSchool of Population Health and Environmental Sciences, King’s College LondonSchool of Population Health and Environmental Sciences, King’s College LondonCentre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College LondonSchool of Population Health and Environmental Sciences, King’s College LondonAbstract 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.https://doi.org/10.1186/s12879-022-07750-3COVID-19SteroidsMortalityRetrospective cohort study |
| spellingShingle | Wenjuan Wang Luke B Snell Davide Ferrari Anna L Goodman Nicholas M Price Charles D Wolfe Vasa Curcin Jonathan D Edgeworth Yanzhong Wang Real-world effectiveness of steroids in severe COVID-19: a retrospective cohort study BMC Infectious Diseases COVID-19 Steroids Mortality Retrospective cohort study |
| title | Real-world effectiveness of steroids in severe COVID-19: a retrospective cohort study |
| title_full | Real-world effectiveness of steroids in severe COVID-19: a retrospective cohort study |
| title_fullStr | Real-world effectiveness of steroids in severe COVID-19: a retrospective cohort study |
| title_full_unstemmed | Real-world effectiveness of steroids in severe COVID-19: a retrospective cohort study |
| title_short | Real-world effectiveness of steroids in severe COVID-19: a retrospective cohort study |
| title_sort | real world effectiveness of steroids in severe covid 19 a retrospective cohort study |
| topic | COVID-19 Steroids Mortality Retrospective cohort study |
| url | https://doi.org/10.1186/s12879-022-07750-3 |
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