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Real-world effectiveness of steroids in severe COVID-19: a retrospective cohort study

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Original languageEnglish
Article number776
JournalBMC infectious diseases
Volume22
DOIs
Accepted/In press6 Sep 2022
Published5 Oct 2022

Bibliographical note

Funding Information: The authors acknowledge use of the research computing facility at King’s College London, Rosalind ( https://rosalind.kcl.ac.uk ), which is delivered in partnership with the National Institute for Health Research (NIHR) Biomedical Research Centres at South London & Maudsley and Guy’s & St. Thomas’ NHS Foundation Trusts and NIHR Applied Research Collaboration (ARC) South London at King’s College Hospital (KCH) NHS Foundation Trust and King’s College London, and part-funded by capital equipment grants from the Maudsley Charity (award 980) and Guy’s & St. Thomas’ Charity (TR130505). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, King’s College London, or the Department of Health and Social Care. Funding Information: This work was supported by the King’s Together Multi and Interdisciplinary Research Scheme (Wellcome Trust Revenue Retention Award). LBS, and YW are supported by the National Institute for Health Research (NIHR) Biomedical Research Centre programme of Infection and Immunity (RJ112/N027) based at Guy’s and St Thomas’ National Health Service NHS) Foundation Trust and King’s College London and was funded by the National Institute for Health Research (NIHR) [Programme Grants for Applied Research (NIHR202339)]. This work was also supported by The Health Foundation and the Guy’s and St Thomas’ Charity. COG-UK is supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI), the National Institute of Health Research (NIHR) and Genome Research Limited, operating as the Wellcome Sanger Institute. VC is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London, and the Public Health and Multi-morbidity Theme of the National Institute for Health Research’s Applied Research Collaboration (ARC) South London. VC is also supported by the EPSRC CONSULT grant (EP/P010105/1). VC is partly funded by the EPSRC project Consult: Collaborative Mobile Decision Support for Managing Multiple Morbidities, EP/P000339/1. LBS receives funding from the Medical Research Council (MR/W025140/1). DF is also partly funded by DRIVE-Health, KCL funded Centre for Doctoral Training (CDT) in Data-Driven Health. Publisher Copyright: © 2022, The Author(s).

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Abstract

Introduction: Randomised controlled trials have shown that steroids reduce the risk of dying in patients with severe Coronavirus disease 2019 (COVID-19), whilst many real-world studies have failed to replicate this result. We aim to investigate real-world effectiveness of steroids in severe COVID-19.


Methods: Clinical, demographic, and viral genome data extracted from electronic patient record (EPR) was analysed from all SARS-CoV-2 RNA positive patients admitted with severe COVID-19, defined by hypoxia at presentation, between March 13th 2020 and May 27th 2021. Steroid treatment was measured by the number of prescription-days with dexamethasone, hydrocortisone, prednisolone or methylprednisolone. The association between steroid > 3 days treatment and disease outcome was explored using multivariable cox proportional hazards models with adjustment for confounders (including age, gender, ethnicity, co-morbidities and SARS-CoV-2 variant). The outcome was in-hospital mortality.


Results: 1100 severe COVID-19 cases were identified having crude hospital mortality of 15.3%. 793/1100 (72.1%) individuals were treated with steroids and 513/1100 (46.6%) received steroid ≤ 3 days. From the multivariate model, steroid > 3 days was associated with decreased hazard of in-hospital mortality (HR: 0.47 (95% CI: 0.31–0.72)).


Conclusion: The protective effect of steroid treatment for severe COVID-19 reported in randomised clinical trials was replicated in this retrospective study of a large real-world cohort.

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