Endocrinol Metab.  2023 Apr;38(2):253-259. 10.3803/EnM.2022.1607.

Mortality and Severity of Coronavirus Disease 2019 in Patients with Long-Term Glucocorticoid Therapy: A Korean Nationwide Cohort Study

• Ku EJ
• Song K
• Kim KM
• Seo GH
• Yoo SJ

• KMID: 2541881
• DOI: http://doi.org/10.3803/EnM.2022.1607

Abstract

Background
The severity of coronavirus disease 2019 (COVID-19) among patients with long-term glucocorticoid treatment (LTGT) has not been established. We aimed to evaluate the association between LTGT and COVID-19 prognosis.
Methods
A Korean nationwide cohort database of COVID-19 patients between January 2019 and September 2021 was used. LTGT was defined as exposure to at least 150 mg of prednisolone (≥5 mg/day and ≥30 days) or equivalent glucocorticoids 180 days before COVID-19 infection. The outcome measurements were mortality, hospitalization, intensive care unit (ICU) admission, length of stay, and mechanical ventilation.
Results
Among confirmed patients with COVID-19, the LTGT group (n=12,794) was older and had a higher proportion of comorbidities than the control (n=359,013). The LTGT group showed higher in-hospital, 30-day, and 90-day mortality rates than the control (14.0% vs. 2.3%, 5.9% vs. 1.1%, and 9.9% vs. 1.8%, respectively; all P<0.001). Except for the hospitalization rate, the length of stay, ICU admission, and mechanical ventilation proportions were significantly higher in the LTGT group than in the control (all P<0.001). Overall mortality was higher in the LTGT group than in the control group, and the significance remained in the fully adjusted model (odds ratio [OR], 5.75; 95% confidence interval [CI], 5.31 to 6.23) (adjusted OR, 1.82; 95% CI, 1.67 to 2.00). The LTGT group showed a higher mortality rate than the control within the same comorbidity score category.
Conclusion
Long-term exposure to glucocorticoids increased the mortality and severity of COVID-19. Prevention and early proactive measures are inevitable in the high-risk LTGT group with many comorbidities.

Keyword

COVID-19; Glucocorticoids; Long term adverse effects; Mortality

Figure

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  Fig. 1. Flow chart showing the study population. COVID-19, coronavirus disease 2019.

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  Fig. 2. Kaplan-Meier survival curves showing data of the long-term glucocorticoid treatment (LTGT) group compared with the control group stratified by the Charlson comorbidity index (CCI) score. Survival probability is plotted on the Y-axis against time after coronavirus disease 2019 (COVID-19) infection on the X-axis. Different colors (green, blue, and red) represent different CCI scores (CCI=0, CCI=1, and CCI ≥2, respectively). The solid and dotted lines represent the LTGT and control groups, respectively. Within the same CCI score category, comparisons between the groups were considered as significant if P<0.05.

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