Corticosteroids for hospitalized patients with severe/critical COVID-19: a retrospective study in Chongqing, China
Rongjuan Zhuang, Hongli Xia, Li Xu, Zhiqiang Liu, Kaican Zong, Hailang Peng, Bin Liu, Huizi Wu, Lan Huang, Hongwei Yang, Chun Luo, Yuting Yin, Shuliang Guo
Scientific Reports, doi:10.1038/s41598-024-75926-9
Corticosteroids have always been recommended for severe cases of COVID-19. However, the efficacy of treatment with corticosteroids for COVID-19 during the SARS-CoV-2 omicron outbreak in China has not been reported. Clinical data from 406 patients hospitalized for severe/critical COVID-19 from December 2022 to January 2023 at six hospitals in Chongqing were retrospectively analyzed. The primary outcome was all-cause mortality at 28 days in the groups with and without corticosteroids treatment after propensity score matching (PSM). Secondary outcomes were to compare in-hospital mortality and length of survival time with corticosteroids and those without corticosteroids. This study included 406 patients with severe or critical COVID-19, divided into the corticosteroids group (231, 56.9%) and non-corticosteroids group (175, 43.1%). After PSM, the use of corticosteroids did not reduce all-cause mortality at 28 days (42.5% vs. 39.1%). Univariate analysis showed that corticosteroids were not associated with improved all-cause mortality at 28 days [hazard ratio (HR), 1.019; 95% confidence interval (CI), 0.639-1.623; p = 0.938]. Multivariate analysis showed similar results (HR, 1.047; 95% CI, 0.633-1.732; p = 0.858). Among non-survivors, the survival time was significantly larger in those who received corticosteroids compared with the non-corticosteroid users [median 13 (IQR 6.5-15.5) vs. 6 (4-11.25), p = 0.007]. The use of systemic corticosteroids in severe/critical COVID-19 may provide certain potential survival benefits but does not improve prognosis.
Author contributions R.Z. and H.X. participated in the study design. Z.L., K.Z., H.P., B.L., H.W., L.H., H.Y., C.L., and Y.Y. collected the epidemiological and clinical data. R.Z. and H.X. performed the statistical analysis and drafted the manuscript. L.X. Conducted the literature search and data extraction. S.G. revised the final manuscript. All authors reviewed and approved the final version of the manuscript.
Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki. The study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (K2023-066). The institutional review board of the First Affiliated Hospital of Chongqing Medical University, Jinshan Campus of the First Affiliated Hospital of Chongqing Medical University, The Seventh People's Hospital of Chongqing, People's Hospital of Shapingba District, Affiliated University Town Hospital of Chongqing Medical University and Chongqing University Three Gorges Hospital approved the analysis of patients' clinical and radiological data. Because of the retrospective nature of the study, the requirement for informed consent was waived by the Medical Ethics Committee of the First Affiliated Hospital of Chongqing Medical University. The data were deidentified and only then transferred for analysis.
Consent for publication All authors have accepted responsibility for the entire content of this manuscript and..
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