Critical Care (Nov 2020)

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

  • 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

DOI
https://doi.org/10.1186/s13054-020-03340-4
Journal volume & issue
Vol. 24, no. 1
pp. 1 – 10

Abstract

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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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