Low-to-moderate dose corticosteroids treatment in hospitalized adults with COVID-19

Liu, Zhibo; Li, Xia; Fan, Guohui; Zhou, Fei; Wang, Yeming; Huang, Lixue; Yu, Jiapei; Yang, Luning; Shang, Lianhan; Xie, Ke; Xu, Jiuyang; Huang, Zhisheng; Gu, Xiaoying; Li, Hui; Zhang, Yi; Wang, Yimin; Huang, Zhenghui; Cao, Bin

OBJECTIVES: Use of corticosteroids is common in the treatment of coronavirus disease 2019, but the clinical effectiveness was controversial. We aimed to investigate the association of corticosteroids therapy with clinical outcomes of hospitalized COVID-19 patients. METHODS: In this single center, retrospective cohort study, adult patients with confirmed coronavirus disease 2019 and dead or discharged between December 29, 2019 and February 15, 2020 were studied. 1:1 propensity score matchings were performed between patients with or without corticosteroids treatment. Multivariable COX proportional hazards model was used to estimate the association between corticosteroids treatment and in-hospital mortality by taking corticosteroids as a time-varying covariate. RESULTS: Among 646 patients, in-hospital death rate was higher in 158 patients with corticosteroids administration (72/158, 45.6% vs 56/488, 11.5%, p<0.0001). After propensity score-match analysis, no significant differences were observed in in-hospital death between patients with and without corticosteroids treatment (47/124, 37.9% vs 47/124, 37.9%, p=1.000). When patients received corticosteroids before they required nasal high-flow oxygen therapy or mechanical ventilation, in-hospital death rate was lower than that in patients who were not administered with corticosteroids (17/86, 19.8% vs. 26/86, 30.2%, log rank p=0.0102), whereas time from admission to clinical improvement was longer (13 [IQR, 10∼17] days vs 10 [IQR, 8∼13] days; p＜0.001). Using Cox proportional hazards regression model accounting for time varying exposures in matched pairs, corticosteroid therapy was not associated with mortality difference (HR=0.98, 95%CI: 0.93-1.03, p=0.4694). CONCLUSIONS: Corticosteroids use in COVID-19 patients may not be associated with in-hospital mortality.