Korean J Intern Med.
2023 May;38(3):382-392. 10.3904/kjim.2022.201.
Corticosteroid outcome may be dependent of duration of use in severe COVID-19
- Affiliations
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- 1Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- 2Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju, Korea
- 3Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon, Korea
- 4Department of Applied Statistics, Chung-Ang University, Seoul, Korea
- 5Division of Allergy and Pulmonology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
- 6Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
- 7Division of Allergy and Respiratory Diseases, Soonchunhyang University Hospital, Seoul, Korea
- 8Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
- KMID: 2541925
- DOI: http://doi.org/10.3904/kjim.2022.201
Abstract
- Background/Aims
For patients hospitalized with coronavirus disease 2019 (COVID-19) who require supplemental oxygen, the evidence of the optimal duration of corticosteroid is limited. This study aims to identify whether long-term use of corticosteroids is associated with decreased mortality.
Methods
Between February 10, 2020 and October 31, 2021, we analyzed consecutive hospitalized patients with COVID-19 with severe hypoxemia. The patients were divided into short-term (≤ 14 days) and long-term (> 14 days) corticosteroid users. The primary outcome was 60-day mortality. We performed propensity score (PS) analysis to mitigate the effect of confounders and conducted Kaplan-Meier curve analysis.
Results
There were 141 (52%) short-term users and 130 (48%) long-term corticosteroid users. The median age was 68 years and the median PaO2/FiO2 at admission was 158. Of the patients, 40.6% required high-flow nasal cannula, 48.3% required mechanical ventilation, and 11.1% required extracorporeal membrane oxygenation. The overall 60-day mortality rate was 23.2%, and that of patients with hospital-acquired pneumonia (HAP) was 22.9%. The Kaplan-Meier curve for 60- day survival in the PS-matched cohort showed that corticosteroid for > 14 days was associated with decreased mortality (p = 0.0033). There were no significant differences in bacteremia and HAP between the groups. An adjusted odds ratio for the risk of 60-day mortality in short-term users was 5.53 (95% confidence interval, 1.90–18.26; p = 0.003).
Conclusions
For patients with severe COVID-19, long-term use of corticosteroids was associated with decreased mortality, with no increase in nosocomial complications. Corticosteroid use for > 14 days can benefit patients with severe COVID-19.
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