Corticosteroids in patients hospitalized for COVID-19 pneumonia who require oxygen: observational comparative study using routine care data

Abstract

Objective To assess the effectiveness of corticosteroids on outcomes of patients with COVID-19 pneumonia requiring oxygen without mechanical ventilation. Methods We used routine care data from 51 hospitals in France and Luxembourg to assess the effectiveness of corticosteroids at 0.8 mg/kg/day eq. prednisone (CTC group) versus standard of care (no-CTC group) among adults 18 to 80 years old with confirmed COVID-19 pneumonia requiring oxygen without mechanical ventilation. The primary outcome was intubation or death by day 28. In our main analysis, characteristics of patients at baseline (i.e., time when patients met all inclusion criteria) were balanced by using propensity-score inverse probability of treatment weighting. Results Among the 891 patients included in the analysis, 203 were assigned to the CTC group. Use of corticosteroids was not significantly associated with risk of intubation or death by day 28 (weighted hazard ratio [wHR] 0.92, 95% CI 0.61 to 1.39) or cumulative death rate (wHR 1.03, 95% CI 0.54 to 1.98). However, use of corticosteroids was associated with reduced risk of intubation or death by day 28 in the prespecified subgroups of patients requiring oxygen ≥ 3 L/min (wHR 0.50, 95% CI 0.30 to 0.85) or C-reactive protein level ≥ 100 mg/L (wHR 0.44, 95%CI 0.23 to 0.85). Number of hyperglycaemia events was higher for patients with than without corticosteroids, but number of infections was similar. Conclusions We found no association between the use of corticosteroids and intubation or death in the broad population of patients 18 to 80 years old with COVID-19 hospitalized in non-intensive care unit settings. However, the treatment was associated with reduced risk of intubation or death for patients with ≥ 3 L/min oxygen or C-reactive protein level ≥ 100 mg/L at baseline. Further research need to confirm the right timing of corticosteroids for patients with COVID-19 requiring oxygen only.

Impact of early corticosteroids on 60-day mortality in critically ill patients with COVID-19: A multicenter cohort study of the OUTCOMEREA network

“…Indeed, in our cohort, patients without inflammation had less severe pneumonia symptoms ( S5 Table ). Our results are consistent with those of other studies which also found that steroids were beneficial in the subgroup of patients with inflammation [ 15 , 19 , 39 ]. Another observational study reported similar results but also a deleterious effect of CS for patients with a C-Reactive protein below 10 mg/dL [ 40 ].…”

“…The subsequent MEtCOVID trial did not show a difference in mortality at day 28 between treatment groups [15] but suggested a benefit of CS in patients aged over 60. Finally, several observational studies yielded conflicting results [19][20][21][22][23].…”

Corticosteroids prescription for mild-moderate COVID-19 in Primary Care

“…The optimal timing of corticosteroid prescription is still controversial, and the indication "in patients requiring oxygen" may be ambiguous. However, an exciting report trying to clarify the timely medication found that only the patients requiring ≥ 3 L/min and CRP ≥ 100 mg/L who received corticosteroids had less risk of death or intubation [9]. This finding suggests a rationale for corticosteroid prescription based on a combination of oxygen supplementation with inflammatory biomarkers.…”

COVID-19 : les thérapeutiques

“…Dans celle-ci, aucune association n'a été retrouvée entre l'utilisation de corticostéroïdes et l'intubation ou le décès dans la population de patients âgés de 18 à 80 ans hospitalisés dans des unités de soins non intensifs. Cependant, le traitement a été associé à une réduction du risque d'intubation ou de décès dans le sous-groupe des patients avec ≥ 3 L/min d'oxygène, ou avec un taux de protéine C-réactive (CRP) ≥ 100 mg/L [22] .…”