ERJ Open Research (Sep 2024)
1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study
- Olivia C. Leavy,
- Richard J. Russell,
- Ewen 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,
- Caroline Jolley,
- A.A. Roger Thompson,
- Trudie Chalder,
- Melanie J. Davies,
- Anthony De Soyza,
- John R. Geddes,
- William Greenhalf,
- Simon Heller,
- Luke Howard,
- Joseph Jacob,
- R. Gisli Jenkins,
- Janet M. Lord,
- Will D-C. Man,
- Gerry P. McCann,
- Stefan Neubauer,
- Peter 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,
- Rachael A. Evans
Affiliations
- Olivia C. Leavy
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- Richard J. Russell
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Ewen M. Harrison
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
- Nazir I. Lone
- The Usher Institute, University of Edinburgh, Edinburgh, UK
- Steven Kerr
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
- Annemarie B. Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
- Aziz Sheikh
- The Usher Institute, University of Edinburgh, Edinburgh, UK
- Matthew Richardson
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Omer Elneima
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Neil J. Greening
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Victoria Claire Harris
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Linzy Houchen-Wolloff
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University of Leicester, Leicester, UK
- Hamish J.C. McAuley
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Ruth M. Saunders
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Marco Sereno
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Aarti Shikotra
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Amisha Singapuri
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Raminder Aul
- St George's University Hospitals NHS Foundation Trust, London, UK
- Paul Beirne
- The Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Charlotte E. Bolton
- University of Nottingham, Nottingham, UK
- Jeremy S. Brown
- UCL Respiratory, Department of Medicine, University College London, Rayne Institute, London, UK
- Gourab Choudhury
- University of Edinburgh, Edinburgh, UK
- Nawar Diar Bakerly
- Manchester Metropolitan University, Manchester, UK
- Nicholas Easom
- Infection Research Group, Hull University Teaching Hospitals, Hull, UK
- Carlos Echevarria
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Jonathan Fuld
- Department of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Nick Hart
- Lane Fox Respiratory Service, Guy's and St Thomas NHS Foundation Trust, London, UK
- John R. Hurst
- University College London, London, UK
- Mark Jones
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Dhruv Parekh
- University of Birmingham, Birmingham, UK
- Paul Pfeffer
- Barts Health NHS Trust, London, UK
- Najib M. Rahman
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Sarah Rowland-Jones
- University of Sheffield, Sheffield, UK
- Ajay M. Shah
- Kings College London, London, UK
- Dan G. Wootton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Caroline Jolley
- Kings College London, London, UK
- A.A. Roger Thompson
- University of Sheffield, Sheffield, UK
- Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Melanie J. Davies
- University Hospitals of Leicester NHS Trust, Leicester, UK
- Anthony De Soyza
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- John R. Geddes
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK
- William Greenhalf
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Luke Howard
- Imperial College Healthcare NHS Trust, London, UK
- Joseph Jacob
- Centre for Medical Image Computing, University College London, London, UK
- R. Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, UK
- Janet M. Lord
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Will D-C. Man
- Royal Brompton and Harefield Clinical Group, Guy's and St Thomas NHS Foundation Trust, London, UK
- Gerry P. McCann
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Stefan Neubauer
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK
- Peter J.M. Openshaw
- National Heart and Lung Institute, Imperial College London, London, UK
- Joanna Porter
- UCL Respiratory, Department of Medicine, University College London, Rayne Institute, London, UK
- Matthew J. Rowland
- Kadoorie Centre for Critical Care Research, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Janet T. Scott
- MRC–University of Glasgow Centre for Virus Research, Glasgow, UK
- Malcolm G. Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Sally J. Singh
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- David Thomas
- Imperial College London, London, UK
- Mark Toshner
- NIHR Cambridge Clinical Research Facility, Cambridge, UK
- Keir Lewis
- Hywel Dda University Health Board, Wales, UK
- Liam G. Heaney
- Wellcome–Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
- Andrew Briggs
- London School of Hygiene and Tropical Medicine, London, UK
- Bang Zheng
- London School of Hygiene and Tropical Medicine, London, UK
- Mathew Thorpe
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
- Jennifer K. Quint
- NHLI, Imperial College London, London, UK
- James D. Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- Ling-Pei Ho
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Alex Horsley
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Michael Marks
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Krisnah Poinasamy
- Asthma and Lung UK, London, UK
- Betty Raman
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Louise V. Wain
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- Christopher E. Brightling
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Rachael A. Evans
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- DOI
- https://doi.org/10.1183/23120541.00474-2024
- Journal volume & issue
-
Vol. 10,
no. 5
Abstract
Background 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. Methods 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. Findings 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±sd change −0.12±0.22 versus −0.11±0.22). Overall, there were no differences in secondary outcome measures. After sensitivity analyses modelled using a cohort of 109 318 patients admitted to hospital with COVID-19, EQ-5D-5L UI at 1 year remained similar between the two groups. Interpretation 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.
