Evaluation of Corticosteroid Use and Secondary Infection Rates in Critically Ill Covid-19 Patients

ABSTRACT

INTRODUCTION: Corticosteroids have shown to decrease mortality and increase ventilator-free days in the treatment of COVID-19. The incidence of and risk factors for secondary infections (SI) associated with corticosteroid use in COVID-19 patients are not well defined. The purpose of this study was to assess the incidence and impact of dose and duration of corticosteroids on the rate of secondary infections (SI) in critically-ill COVID-19 patients. METHOD(S) This multi-center, single health-system, retrospective cohort study evaluated adults (>=18 years) admitted to an intensive care unit (ICU) who received corticosteroid(s) for the treatment of COVID-19 between March 2020 and August 2021. Patients were excluded for ICU stay < 24 hours or if the patient transferred from another hospital. The primary endpoint was rate of SI defined as a positive microbiological result after initial corticosteroid administration and at least 48 hours after admission. Secondary endpoints were compared in those who did and did not develop SI and included but not limited to cumulative corticosteroid dose, duration of corticosteroid, receipt of recommended corticosteroid regimen(s), ICU length of stay (LOS), hospital LOS, in-hospital mortality, 90-day mortality, and ventilator-free days. Secondary outcomes were adjusted for pre-specified variables. RESULT(S) Of the 910 patients included in analyses, 300 patients (32%) experienced SI. Patients who developed SI had higher use of prolonged corticosteroid courses (79.3% vs 44.9%, p< 0.001) and higher cumulative steroid doses (238 vs 124 mg dexamethasone equivalents;aOR 1.008;95% CI, 1.006-1.009;p< 0.001) and longer median (IQR) corticosteroid duration 16 days (11-25) vs 11 days (9-17);aOR 1.12, 1.09-1.14;p< 0.001). The use of recommended corticosteroid regimen was lower in patients with SI 11.7% vs. 39.3% (p< 0.001). Patients with SI had more ventilator days, longer ICU and hospital LOS and increased in-hospital and 90-day mortality (p< 0.001). CONCLUSION(S) In patients who received corticosteroids for COVID-19, exceeding recommended dosing strategies by either prolonging treatment or receiving higher cumulative doses was associated with increased rates of SI. Patients with SI were more likely to experience increased ICU LOS, ventilator days and mortality.