One year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study
Olivia C Leavy, Ewen Richard J Russell, M Harrison, Nazir I Lone, Steven Kerr, Annemarie B Docherty, Aziz Sheikh, Matthew Richardson, Omer Elneima, Neil J Greening, Victoria Claire Harris, Linzy Houchen-Wolloff, Hamish J C Mcauley, Ruth M Saunders, Marco Sereno, Aarti Shikotra, Amisha Singapuri, Raminder Aul, Paul Beirne, Charlotte E Bolton, Jeremy S Brown, Gourab Choudhury, Nawar Diar Bakerly, Nicholas Easom, Carlos Echevarria, Jonathan Fuld, Nick Hart, John R Hurst, Mark Jones, Dhruv Parekh, Paul Pfeffer, Najib M Rahman, Sarah Rowland-Jones, Ajay M Shah, Dan G Wootton, AA Caroline Jolley, Roger Thompson, Trudie Chalder, Melanie J Davies, Anthony De Soyza, John R Geddes, William Greenhalf, Simon Heller, Luke Howard, Joseph Jacob, Gisli Jenkins, Janet M Lord, D-C Man, Gerry P Mccann, Peter Stefan Neubauer, J M Openshaw, Joanna Porter, Matthew J Rowland, Janet T Scott, Malcolm G Semple, Sally J Singh, David Thomas, Mark Toshner, Keir Lewis, Liam G Heaney, Andrew Briggs, Bang Zheng, Mathew Thorpe, Jennifer K Quint, James D Chalmers, Ling-Pei Ho, Alex Horsley, Michael Marks, Krisnah Poinasamy, Betty Raman, Louise V Wain, Christopher E Brightling, Dr Rachael A Evans, Ewen M Harrison, Nawar Diar Bakerly, Sarah Rowland- Jones, Peter Jm Openshaw
doi:10.1183/23120541.00474
Systemic corticosteroids given for acute COVID-19 do not affect health-related quality of life or other patient reported outcomes, physical and mental health outcomes, and organ function one year after hospital discharge
Conflict of interest statement: AART declares that their institute was awarded a fellowship from British Heart Foundation and grant funding from Heart Research UK and National Institute for Health and Care Research; payment for lectures and presentations received from Janssen-Cilag Ltd; support for attending meetings from Janssen-Cilag Ltd. AH declares that their institute was awarded funding from UK
Supplementary methodssensitivity analysis Sensitivity analyses were performed using the ISARIC (UK) dataset to address selection bias, treatment bias and survivor bias in PHOSP-COVID. First, a propensity score weighting for corticosteroid treatment was developed in the ISARIC (UK) cohort (survivors and non-survivors) using logistic regression with the following covariates: age, sex, obesity status, Index of Multiple Deprivation, WHO Clinical Progression Scale status, and the presence of specific comorbidities (cardiovascular disease, hypertension, chronic pulmonary disease, liver disease, renal disease, chronic neurological disease, malignancy, diabetes and rheumatological diseases). Second, using the PHOSP-COVID dataset, a prediction model was developed for EQ-5D-5L utility index at one year. Given the distribution of this measure, several modelling approaches were compared: linear regression, random forest, gradient boosted trees, and generalised linear models with gamma distribution (log link), poisson distribution, and zero-inflated poisson distribution. Based on..
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'abstract': '<jats:sec><jats:title>Background</jats:title><jats:p>In patients with coronavirus disease '
'2019 (COVID-19) requiring supplemental oxygen, dexamethasone reduces acute severity and '
'improves survival, but longer-term effects are unknown. We hypothesised that systemic '
'corticosteroid administration during acute COVID-19 would be associated with improved '
'health-related quality of life (HRQoL) 1 year after '
'discharge.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Adults '
'admitted to hospital between February 2020 and March 2021 for COVID-19 and meeting current '
'guideline recommendations for dexamethasone treatment were included using two prospective UK '
'cohort studies (Post-hospitalisation COVID-19 and the International Severe Acute Respiratory '
'and emerging Infection Consortium). HRQoL, assessed by the EuroQol-Five Dimensions–Five '
'Levels utility index (EQ-5D-5L UI), pre-hospital and 1 year after discharge were compared '
'between those receiving corticosteroids or not after propensity weighting for treatment. '
'Secondary outcomes included patient-reported recovery, physical and mental health status, and '
'measures of organ impairment. Sensitivity analyses were undertaken to account for survival '
'and selection bias.</jats:p></jats:sec><jats:sec><jats:title>Findings</jats:title><jats:p>Of '
'the 1888 participants included in the primary analysis, 1149 received corticosteroids. There '
'was no between-group difference in EQ-5D-5L UI at 1 year (mean difference 0.004, 95% CI '
'−0.026–0.034). A similar reduction in EQ-5D-5L UI was seen at 1 year between corticosteroid '
'exposed and nonexposed groups (mean±<jats:sc>sd</jats:sc>change '
'−0.12±0.22<jats:italic>versus</jats:italic>−0.11±0.22). Overall, there were no differences in '
'secondary outcome measures. After sensitivity analyses modelled using a cohort of 109\u2009'
'318 patients admitted to hospital with COVID-19, EQ-5D-5L UI at 1 year remained similar '
'between the two '
'groups.</jats:p></jats:sec><jats:sec><jats:title>Interpretation</jats:title><jats:p>Systemic '
'corticosteroids for acute COVID-19 have no impact on the large reduction in HRQoL 1 year '
'after hospital discharge. Treatments to address the persistent reduction in HRQoL are '
'urgently needed.</jats:p></jats:sec>',
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