The adverse effects of high‐dose corticosteroid on infectious and non‐infectious sequelae in renal transplant recipients with coronavirus disease‐19 in India

Abstract

Introduction The corticosteroid dosing modulation in renal transplant recipients (RTRs) with coronavirus disease‐19 (COVID‐19) is not well defined. We aimed to analyze the outcomes and infectious and non‐infectious sequelae in RTR with COVID‐19 with reference to corticosteroid dosing and the first and second pandemic waves of COVID‐19. Materials and methods This study included RTRs admitted during two pandemic waves between March 25, 2020, and July 31, 2021. Patients were categorized into mild, moderate, and severe COVID‐19. The outcomes and predictors of survival at 4 weeks were analyzed. The survivors were also followed for 6 months and were studied for mortality, readmission rates, and infectious and non‐infectious sequelae with reference to high‐dose and standard‐dose corticosteroids. Results A total of 251 RTRs, 104 during the first wave and 147 during the second wave, were treated. Overall mortality was 15.1% (11.5% in the first wave vs. 17.5% in the second wave, p = .23). The use of high‐dose steroids was also significantly high in non‐survivors (85.8% vs. 11.3%, p = .001). On multivariate analysis, the severity of COVID‐19, graft dysfunction, and high dose of corticosteroid therapy were associated with increased odds of mortality. Among survivors, 6‐month mortality (17.3% vs. 0.5%, p = .001), readmission rate (91.3% vs. 23.7%, p = .001), fungal infection (30.4% vs. 2.2%, p < .001), and post‐COVID lung sequelae (21.7% vs. 4.4%, p = .008) were significantly higher in the high‐dose corticosteroid group than in the standard‐dose group. Conclusion High‐dose corticosteroid dosing in RTRs with COVID‐19 was associated with increased infections, particularly fungal infections, and non‐infectious sequelae with higher mortality on subsequent follow‐up.

COVID-19 Outcomes in Kidney Transplant Recipients in a German Transplant Center

“…These findings are in line with observations in the general population, where both vaccination and Omicron variant reduced the risk of severe COVID-19, independently [5]. Within our cohort, we could also confirm that patient age and steroid intake pose risk factors for severe COVID-19, which has been described before in the general population as well as in other cohorts of KTRs [24,[32][33][34].…”

Optimizing treatment administration strategies using negative mNGS results in corticosteroid-sensitive diffuse parenchymal lung diseases

“…During the treatment of infection, the use of corticosteroids is not recommended as it may aggravate the condition. 18 , 19 , 20 However, corticosteroids are the most frequently administrated treatment for DPLD. 8 Ensuring that DPLD patients are in a non-infected state is essential prior to subsequent corticosteroids therapy.…”

Optimal Duration of Systemic Corticosteroids in Coronavirus Disease 2019 Treatment: A Systematic Review and Meta-analysis

“…Similar literature is accumulating regarding adverse effects of steroids specific to patients with COVID-19. Signals of delayed viral clearance [ 39 ], increased antibiotic use, and increased opportunistic infections, including fungal infections [ 40 ], are increasingly reported in COVID-19 patients receiving steroids. The broad immunosuppressive nature of corticosteroids may leave patients prone to secondary infections.…”