The Association of Inhaled Corticosteroid Before Admission and Survival of Patients with COVID-19.

Abstract

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Inhaled corticosteroids (ICS) are widely used in patients with asthma and chronic obstructive pulmonary disease (COPD). The pooled epidemiological studies have shown that patients with asthma or COPD are at lower hospitalization risk, which could be related to the protective effect of ICS. However, some studies showed no protective effects of ICS on the prognosis of COVID-19. The very recent study suggested that the use of ICS, within 2 weeks of admission, improved survival only for patients aged 50 years and older with asthma, but not for those with chronic pulmonary disease. Herein, we are highly concerned about whether the use of ICS affects the prognosis of COVID-19. METHODS: We retrospectively analyzed over 6,095 hospitalized patients with laboratory confirmed COVID-19 at the Mount Sinai Health System in New York between March 1stand May 2nd, 2020. Patients were stratified into those with or without ICS before admission and were assessed for in-hospital mortality as a primary outcome. Patients were matched by propensity score using 1:1 matching scheme without replacement. We performed this analysis with and without multiple imputation for missing data and then performed an inverse probability weighted analysis. All statistical calculations and analyses were performed in R, with p-values <0.05 considered statistically significant. RESULTS: Of the 6,095 patients admitted due to COVID-19 infection, 333 patients (5.5%) used ICS before admission. The patients with ICS were older and had more comorbidities compared to the patients without ICS. However, in-hospital mortality, intensive care unit admission, and endotracheal intubation rate were not significantly different, although the d-dimer levels were significantly lower in patients with ICS compared to those without (1.48 [0.88, 2.76] versus 1.66 [0.88, 3.51] mg/mL, P=0.043). After matching by propensity score (N=204 in each group), in-hospital mortality and intensive care unit admission rate were not different, while endotracheal intubation rate was significantly decreased in the patients with ICS. Multiple imputation for missing data and inverse probability weighted analysis revealed no significant difference in in-hospital mortality between the groups (odds ratio [95% confidential interval]: 0.90 [0.61-1.34], P=0.63;odds ratio [95% confidential interval]: 0.83 [0.54-1.29], P=0.42). To identify the population ICS improves the prognosis of COVID-19, we performed a subgroup analysis among patients with asthma and COPD (N=378). There was no significant difference in in-hospital mortality between patients with ICS and those without even after propensity score matched analysis or inverse probability weighted analysis (odds ratio [95% confidential interval]: 0.86 [0.47-1.60], P=0.64) (Table 1). CONCLUSIONS: In our study, antecedent ICS use showed numerically better outcomes in the propensity score matching analysis and the subgroup analysis of patients with asthma and COPD even though the patients with antecedent ICS use had more comorbidities. Particularly, our propensity score matching analysis revealed that patients with antecedent ICS use showed decreased endotracheal intubation rate. CLINICAL IMPLICATIONS: The potential benefit of antecedent ICS use on COVID-19 patients needs to be examined with larger sample size. DISCLOSURES: No relevant relationships by Natalia Egorova, source=Web Response No relevant relationships by Hiroki Kabata, source=Web Response no disclosure on file for Toshiki Kuno;No relevant relationships by Matsuo So, source=Web Response No relevant relationships by Mai Takahashi, source=Web Response