Association between prolonged corticosteroids use in COVID-19 and increased mortality in hospitalized patients: a retrospective study with inverse probability of treatment weighting analysis.

Autor: Viana MV; Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil. maviana@hcpa.edu.br.; Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. maviana@hcpa.edu.br., Pellegrini JAS; Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil.; Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil., Perez AV; Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil., Schwarz P; Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil., da Silva D; Clinical Pharmacy Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil., Teixeira C; Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil.; Graduate Program in Pneumology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.; Internal Medicine and Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil., Gazzana MB; Graduate Program in Pneumology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.; Pneumology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil., Rech TH; Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil.; Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.; Graduate Program in Pneumology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2023 Apr 15; Vol. 27 (1), pp. 143. Date of Electronic Publication: 2023 Apr 15.
DOI: 10.1186/s13054-023-04434-5
Abstrakt: Background: Previous studies have demonstrated a beneficial effect of early use of corticosteroids in patients with COVID-19. This study aimed to compare hospitalized patients with COVID-19 who received short-course corticosteroid treatment with those who received prolonged-course corticosteroid treatment to determine whether prolonged use of corticosteroids improves clinical outcomes, including mortality.
Methods: This is a retrospective cohort study including adult patients with positive testing for Sars-CoV-2 hospitalized for more than 10 days. Data were obtained from electronic medical records. Patients were divided into two groups, according to the duration of treatment with corticosteroids: a short-course (10 days) and a prolonged-course (longer than 10 days) group. Inverse probability treatment weighting (IPTW) analysis was used to evaluate whether prolonged use of corticosteroids improved outcomes. The primary outcome was in-hospital mortality. Secondary outcomes were hospital infection and the association of different doses of corticosteroids with hospital mortality. Restricted cubic splines were used to assess the nonlinear association between mortality and dose and duration of corticosteroids use.
Results: We enrolled 1,539 patients with COVID-19. Among them, 1127 received corticosteroids for more than 10 days (prolonged-course group). The in-hospital mortality was higher in patients that received prolonged course corticosteroids (39.5% vs. 26%, p < 0.001). The IPTW revealed that prolonged use of corticosteroids significantly increased mortality [relative risk (RR) = 1.52, 95% confidence interval (95% CI): 1.24-1.89]. In comparison to short course treatment, the cubic spline analysis showed an inverted U-shaped curve for mortality, with the highest risk associated with the prolonged use at 30 days (RR = 1.50, 95% CI 1.21-1.78).
Conclusions: Prolonged course of treatment with corticosteroids in hospitalized patients with COVID-19 was associated with higher mortality.
(© 2023. The Author(s).)
Databáze: MEDLINE
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