ABSTRACT
Background Dexamethasone was the first intervention proven to reduce mortality in patients with COVID-19 being treated in hospital. We aimed to evaluate the adoption of corticosteroids in the treatment of COVID-19 in the UK after the RECOVERY trial publication on June 16, 2020, and to identify discrepancies in care. Methods We did an audit of clinical implementation of corticosteroids in a prospective, observational, cohort study in 237 UK acute care hospitals between March 16, 2020, and April 14, 2021, restricted to patients aged 18 years or older with proven or high likelihood of COVID-19, who received supplementary oxygen. The primary outcome was administration of dexamethasone, prednisolone, hydrocortisone, or methylprednisolone. This study is registered with ISRCTN, ISRCTN66726260. Findings Between June 17, 2020, and April 14, 2021, 47 795 (75.2%) of 63 525 of patients on supplementary oxygen received corticosteroids, higher among patients requiring critical care than in those who received ward care (11 185 [86.6%] of 12 909 vs 36 415 [72.4%] of 50 278). Patients 50 years or older were significantly less likely to receive corticosteroids than those younger than 50 years (adjusted odds ratio 0.79 [95% CI 0.70-0.89], p=0.0001, for 70-79 years;0.52 [0.46-0.58], p<0.0001, for >80 years), independent of patient demographics and illness severity. 84 (54.2%) of 155 pregnant women received corticosteroids. Rates of corticosteroid administration increased from 27.5% in the week before June 16, 2020, to 75-80% in January, 2021. Interpretation Implementation of corticosteroids into clinical practice in the UK for patients with COVID-19 has been successful, but not universal. Patients older than 70 years, independent of illness severity, chronic neurological disease, and dementia, were less likely to receive corticosteroids than those who were younger, as were pregnant women. This could reflect appropriate clinical decision making, but the possibility of inequitable access to life-saving care should be considered. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.
ABSTRACT
Background: The symptoms of the COVID-19 acute phase are well studied, but the long-term sequelae (post-COVID condition) are still poorly characterised. The aim of this study was to evaluate the prevalence of persistent symptoms in previously hospitalised adult patients with COVID-19 and assess risk factors for the post-COVID condition Method: Ambidirectional cohort study of patients over 18 years hospitalised to Sechenov University Hospital Network, Moscow, Russia with clinically diagnosed or laboratory-confirmed COVID-19 between April 8 and July 10, 2020. Study participants were interviewed 6-8 months after discharge via telephone using a follow-up case report form (CRF) developed by ISARIC in collaboration with WHO. Identified symptoms were categorised according to organ systems. Risk factors were assessed by multivariate logistic regression. Results: Among 4,755 patients discharged from the hospitals, 2,649 were subsequently interviewed. The median age of patients was 56 years (46-66), and 1,353 patients (51.1%) were female. The follow-up median time was 217.5 days (200.4-235.5). 1,247 (47.1%) participants reported persistent symptoms (since discharge). The most frequent symptoms were fatigue (21.2%, 551/2599), shortness of breath (14.5%, 378/2614) and forgetfulness (9.1%, 237/2597). Female gender was associated with chronic fatigue with an odds ratio of 1.67 (95% confidence interval 1.39-2.02), neurological 2.03 (1.60-2.58), mental 1.83 (1.41-2.40), respiratory 1.31 (1.06-1.62) and dermatological symptoms 3.26 (2.36-4.57), GI disturbances 2.50 (1.64-3.89) and sensory problems 1.73 (2.06-2.89). Pre-existing asthma was associated with a higher risk of neurological 1.95 (1.25-2.98) and mood and behavioural changes 2.02 (1.24-3.18). Conclusion: Six to eight months after COVID-19 nearly half of patients have symptoms lasting since discharge. The main risk factor for the majority of the development of long-term symptoms was female sex. Asthma may also serve as a risk factor for the post-COVID condition. Further follow-up of patients reporting the persistence of COVID-19 symptoms and the development of interventional approaches for the prevention of post-COVID manifestations are needed.