Abstract
There is a paucity of studies investigating the impact of chronic corticosteroid use for coexisting conditions in patients with Coronavirus Disease 2019 (COVID-19). Additionally, the information regarding the impact of chronic liver disease (CLD) on COVID-19 outcomes is evolving. Our study aims to investigate hospitalization outcomes of patients with COVID-19 on long term corticosteroids for coexisting conditions while also seeking to compare outcomes between such patients with a history of CLD to analyze the impact on mortality. We conducted a retrospective chart review across our 10-hospital network identifying patients on chronic corticosteroids (Prednisone ≥ 5 mg daily dose or equivalent dose of another steroid, for a duration of 30 days or more) who were hospitalized with COVID-19 from March 1, 2020 to June 30, 2020. Of these patients who met inclusion criteria, patients were then divided into groups based upon their history of CLD. Primary outcomes of the study looked to investigate the hospitalization outcomes of patients with a history of CLD and comorbid conditions requiring chronic corticosteroid use. Secondary outcomes sought to further investigate risk factors for mortality in our study sample. 837 charts were reviewed. 139 patients met inclusion criteria of which 34 patients had a history of CLD. Statistical analysis demonstrated no difference in length of hospital stay but increased ICU admission rate in the CLD group (41.2% vs 23.8%). No statistically significant difference was seen in between the CLD and non-CLD groups in term of complication rates and 28-day mortality. However, chronic corticosteroids patients were found to have higher rates of ICU admission and overall 28-day and ICU mortality in comparison to patients who were not on chronic corticosteroids prior to COVID-19 hospitalization. The larger contributor to COVID-19 severity was likely chronic corticosteroid use rather than CLD and thus chronic corticosteroid use should be limited throughout the COVID-19 pandemic especially in patients with additional speculated risk factors for COVID-19 such as CLD.
Highlights
There is a paucity of studies investigating the impact of chronic corticosteroid use for coexisting conditions in patients with Coronavirus Disease 2019 (COVID-19)
After its emergence, limited information was available except the information that was extrapolated from preceding coronavirus disease outbreaks including Severe Acute Respiratory Distress Syndrome (SARS) and Middle East Respiratory Distress Syndrome (MERS)
We reviewed all patients who tested positive for COVID-19 with nasopharyngeal swab specimens and confirmatory SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) testing from March 1, 2020 to June 30, 2020 (Fig. 1)
Summary
There is a paucity of studies investigating the impact of chronic corticosteroid use for coexisting conditions in patients with Coronavirus Disease 2019 (COVID-19). We conducted a retrospective chart review across our 10-hospital network identifying patients on chronic corticosteroids (Prednisone ≥ 5 mg daily dose or equivalent dose of another steroid, for a duration of 30 days or more) who were hospitalized with COVID-19 from March 1, 2020 to June 30, 2020 Of these patients who met inclusion criteria, patients were divided into groups based upon their history of CLD. After its emergence, limited information was available except the information that was extrapolated from preceding coronavirus disease outbreaks including Severe Acute Respiratory Distress Syndrome (SARS) and Middle East Respiratory Distress Syndrome (MERS) This knowledge gap prompted robust research that led to a better yet limited understanding of the risk factors, appropriate treatment, and the morbidity and mortality of COVID-19. (9) Our study aims to investigate the hospitalization outcomes of patients with a history of CLD and comorbid conditions requiring chronic corticosteroid use. Our secondary aim was to investigate risk factors for mortality in our study sample
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