Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis

Chao Wu ,Junhua Zheng,Lu Wang,Chunxue Bai,Cuicui Chen,Dongni Hou,Jin‐Fu Xu ,Weining Xiong,Juan Song,Yanping Cai,Chunling Du,Xiaoyan Chen,Jie Xu,Xiaoxin Hu ,Ming Zhong,Yuanjian Zhang ,Yun Feng,Yen Cheng Chao ,Xin Zhou,Jinjun Jiang,Yuanlin Song,Jie Hu,Dechang Chen,Fengyun Gong

doi:10.1186/s13054-020-03340-4

Abstract

BackgroundThe 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.MethodsIn 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.ResultsA 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.ConclusionIn 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.

Highlights

The impact of corticosteroid therapy on outcomes of patients with coronavirus disease 2019 (COVID19) is highly controversial
We thoroughly examined the associations of corticosteroid treatment with 60-day in-hospital mortality among a population of COVID-19 patients who have developed acute respiratory distress syndrome (ARDS)
Forty patients were excluded for participating in any double-blind clinical trial (n = 15), death or discharge from the hospital within 2 days after hospital admission (n = 21), underwent long-term corticosteroid therapy for chronic kidney disease or rheumatic disease (n = 3), or no valid medical history provided because of mental disease (n = 1)

Summary

Introduction

The impact of corticosteroid therapy on outcomes of patients with coronavirus disease 2019 (COVID19) is highly controversial. The World Health Organization (WHO) declared that the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitutes a pandemic [1]. Up to 29% of the COVID-19 patients developed acute respiratory distress syndrome (ARDS) [3,4,5] as a consequence of cytokine storm. There was comprehensive controversy on its efficacy [9, 10], due to the results of observational studies that showed corticosteroid treatment was associated with increased mortality and nosocomial infections for influenza and delayed virus clearance for severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) [11]

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