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Early initiation of corticosteroids in patients hospitalized with COVID-19 not requiring intensive respiratory support: cohort study (preprint)
medrxiv; 2021.
Preprint
Dans Anglais
| medRxiv | ID: ppzbmed-10.1101.2021.07.06.21259982
ABSTRACT
Objectives:
To determine whether early oral or parenteral corticosteroids compared to no corticosteroids are associated with decreased mortality in patients hospitalized with coronavirus disease 2019 (COVID-19) who are not on intensive respiratory support (IRS) within 48 hours of admission.Design:
Observational cohort studySetting:
Nationwide cohort of patients receiving care in the Department of Veterans Affairs, a large integrated US national healthcare systemParticipants:
9,058 patients admitted to a Veterans Affairs Medical Center between June 7, 2020-December 5, 2020 within 14-days after SARS-CoV-2 positive test; exclusion criteria include less than a 48 hour stay, receipt of prior systemic corticosteroids, and no indication of acute medical care for COVID-19. Main outcomemeasure:
90-day all-cause mortalityResults:
Of 9,058 total patients (95% men, median age 71 years, 27% black), 6,825 (75%) were not on IRS within 48 hours. Among the 3,025 patients on no oxygen, 598 (20%) received corticosteroids and 283 (9%) died; of 3,800 patients on low-flow nasal cannula oxygen (NC), 2,808 (74%) received corticosteroids and 514 (13%) died. In stratified, inverse probability weighted Cox proportional hazards models comparing those who did and did not receive corticosteroids, patients on no oxygen experienced an 89% increased risk for 90-day mortality (hazard ratio [HR] 1.89, 95% confidence interval [CI] 1.33 to 2.68); there was weak evidence of increased mortality among patients on NC (HR 1.21, 95% CI 0.94 to 1.57). Results were robust in subgroup analyses including restricting corticosteroids to dexamethasone, and in sensitivity analyses employing different modeling approaches.Conclusions:
In patients hospitalized with COVID-19, we found no evidence of a mortality benefit associated with early initiation of corticosteroids among those on no oxygen or NC in the first 48 hours, though there was evidence of potential harm. These real-world findings support that clinicians should consider withholding corticosteroids in these populations and further clinical trials may be warranted.
Texte intégral:
Disponible
Collection:
Preprints
Base de données:
medRxiv
Sujet Principal:
COVID-19
langue:
Anglais
Année:
2021
Type de document:
Preprint
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