Corticosteroids treatment in severe patients with COVID-19: a propensity score matching study

ABSTRACT

Objectives

To explore the efficacy of corticosteroid treatment in patients with severe COVID-19 pneumonia and the association between corticosteroid use and patient mortality.

Methods

A retrospective investigation was made on the medical records of the patients with severe and critical patients with COVID-19 pneumonia from January to February 2020. First, the patients who received corticosteroid treatment were compared with patients without given corticosteroid treatment. Then, a propensity score matching method was used to control confounding factors. Cox survival regression analysis was used to evaluate the effect of corticosteroid therapy on the mortality of severe and critical patients with COVID-19.

Results

A total of 371 severe and critical patients were included in our analyses. Two hundred and enine patients were treated with corticosteroid therapy. Most of them were treated with methylprednisolone (197[94.3%]). The median corticosteroid therapy was applied 3 (IQR 2–6) days after admission, 13 (IQR 10–17) days after symptoms appeared. Temperature on admission (OR = 1.255, [95%CI 1.021–1.547], p = 0.032), ventilation (OR = 1.926, [95%CI 1.148–3.269], p = 0.014) and ICU admission (OR = 3.713, [95%CI 1.776–8.277], p < 0.001) were significantly associated with corticosteroids use. After PS matching, the cox regression survival analysis showed that corticosteroid use was significantly associated with a lower mortality rate (HR = 0.592, [95%CI 0.406–0.862], p = 0.006).

Conclusion

Corticosteroid therapy use in severe and critical patients with COVID-19 pneumonia leads to lower mortality but may cause other side effects. Corticosteroid therapy should be used carefully.

KEYWORDS:

• COVID-19 pneumonia
• corticosteroid therapy
• critical
• mortality
• severe

Author contributions

Study design: Tao Wang, Jingdong Ma. Data extraction and data entry: Lu Wang, Yipeng Zhang, Lu Han, Jingru Liu, Mengyu Yang. Data collection: Qian Chen, Yang Song, Lu Wang. Data analysis: Jingdong Ma, Yang Song. Drafting manuscript: Jingdong Ma, Yang Song. Revising manuscript content: Tao Wang, Jingdong Ma, Yang Song. Approving the final version of the manuscript: Tao Wang, Jingdong Ma, Yang Song. All authors read and approved the final manuscript.

Ethics approval and consent to participate

The study was approved by the Ethics Committee of Tongji Hospital ((IRB: TJ-IRB20200353)). Patient identities were protected via anonymization, and the requirement for informed consent was waived due to the observational nature of the study. Written informed consent for publication was obtained from all participants.

Data availability

The dataset used and analyzed during the current study are available from the corresponding author on reasonable request.

Acknowledgments

We thank all medical staffs and patients involved in the study.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript received an honorarium for their review work. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Notes

1. Some patients changed corticosteroid type during the treatment process. For rigors’ sake, here are the statistics of patients who have used this type of corticosteroid drug. Which means that these percentages add up to more than 1 due to some patients received more than 1 type of corticosteroids.

Additional information

Funding

This work was supported by HUST COVID-19 Rapid Response Call 2020kfyXGYJ015 to Tao Wang.