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Critical Care
Published in: Critical Care 1/2020

01-12-2020 | SARS-CoV-2 | Research

Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis

Authors: Chaomin Wu, Dongni Hou, Chunling Du, Yanping Cai, Junhua Zheng, Jie Xu, Xiaoyan Chen, Cuicui Chen, Xianglin Hu, Yuye Zhang, Juan Song, Lu Wang, Yen-cheng Chao, Yun Feng, Weining Xiong, Dechang Chen, Ming Zhong, Jie Hu, Jinjun Jiang, Chunxue Bai, Xin Zhou, Jinfu Xu, Yuanlin Song, Fengyun Gong

Published in: Critical Care | Issue 1/2020

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Abstract

Background

The impact of corticosteroid therapy on outcomes of patients with coronavirus disease 2019 (COVID-19) is highly controversial. We aimed to compare the risk of death between COVID-19-related ARDS patients with corticosteroid treatment and those without.

Methods

In this single-center retrospective observational study, patients with ARDS caused by COVID-19 between January 20, 2020, and February 24, 2020, were enrolled. The primary outcome was 60-day in-hospital death. The exposure was prescribed systemic corticosteroids or not. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for 60-day in-hospital mortality.

Results

A total of 382 patients [60.7 ± 14.1 years old (mean ± SD), 61.3% males] were analyzed. The median of sequential organ failure assessment (SOFA) score was 2.0 (IQR 2.0–3.0). Of these cases, 94 (24.6%) patients had invasive mechanical ventilation. The number of patients received systemic corticosteroids was 226 (59.2%), and 156 (40.8%) received standard treatment. The maximum dose of corticosteroids was 80.0 (IQR 40.0–80.0) mg equivalent methylprednisolone per day, and duration of corticosteroid treatment was 7.0 (4.0–12.0) days in total. In Cox regression analysis using corticosteroid treatment as a time-varying variable, corticosteroid treatment was associated with a significant reduction in risk of in-hospital death within 60 days after adjusting for age, sex, SOFA score at hospital admission, propensity score of corticosteroid treatment, comorbidities, antiviral treatment, and respiratory supports (HR 0.42; 95% CI 0.21, 0.85; p = 0.0160). Corticosteroids were not associated with delayed viral RNA clearance in our cohort.

Conclusion

In this clinical practice setting, low-dose corticosteroid treatment was associated with reduced risk of in-hospital death within 60 days in COVID-19 patients who developed ARDS.
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Metadata
Title
Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis
Authors
Chaomin Wu
Dongni Hou
Chunling Du
Yanping Cai
Junhua Zheng
Jie Xu
Xiaoyan Chen
Cuicui Chen
Xianglin Hu
Yuye Zhang
Juan Song
Lu Wang
Yen-cheng Chao
Yun Feng
Weining Xiong
Dechang Chen
Ming Zhong
Jie Hu
Jinjun Jiang
Chunxue Bai
Xin Zhou
Jinfu Xu
Yuanlin Song
Fengyun Gong
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-03340-4

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