Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: a cohort study with pro
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RESEARCH
Corticosteroid therapy for coronavirus disease 2019‑related acute respiratory distress syndrome: a cohort study with propensity score analysis Chaomin Wu1,2†, Dongni Hou2†, Chunling Du1†, Yanping Cai3†, Junhua Zheng4†, Jie Xu5, Xiaoyan Chen2, Cuicui Chen2, Xianglin Hu2, Yuye Zhang2, Juan Song2, Lu Wang2, Yen‑cheng Chao2, Yun Feng6, Weining Xiong7, Dechang Chen8, Ming Zhong9, Jie Hu2, Jinjun Jiang2, Chunxue Bai2, Xin Zhou10, Jinfu Xu11, Yuanlin Song1,2,12,13,14* and Fengyun Gong3*
Abstract Background: The impact of corticosteroid therapy on outcomes of patients with coronavirus disease 2019 (COVID19) is highly controversial. We aimed to compare the risk of death between COVID-19-related ARDS patients with corticosteroid treatment and those without. Methods: In this single-center retrospective observational study, patients with ARDS caused by COVID-19 between January 20, 2020, and February 24, 2020, were enrolled. The primary outcome was 60-day in-hospital death. The expo‑ sure was prescribed systemic corticosteroids or not. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for 60-day in-hospital mortality. Results: A total of 382 patients [60.7 ± 14.1 years old (mean ± SD), 61.3% males] were analyzed. The median of sequential organ failure assessment (SOFA) score was 2.0 (IQR 2.0–3.0). Of these cases, 94 (24.6%) patients had invasive mechanical ventilation. The number of patients received systemic corticosteroids was 226 (59.2%), and 156 (40.8%) received standard treatment. The maximum dose of corticosteroids was 80.0 (IQR 40.0–80.0) mg equivalent meth‑ ylprednisolone per day, and duration of corticosteroid treatment was 7.0 (4.0–12.0) days in total. In Cox regression analysis using corticosteroid treatment as a time-varying variable, corticosteroid treatment was associated with a sig‑ nificant reduction in risk of in-hospital death within 60 days after adjusting for age, sex, SOFA score at hospital admis‑ sion, propensity score of corticosteroid treatment, comorbidities, antiviral treatment, and respiratory supports (HR 0.42; 95% CI 0.21, 0.85; p = 0.0160). Corticosteroids were not associated with delayed viral RNA clearance in our cohort. Conclusion: In this clinical practice setting, low-dose corticosteroid treatment was associated with reduced risk of in-hospital death within 60 days in COVID-19 patients who developed ARDS.
*Correspondence: [email protected]; [email protected] † Chaomin Wu, Dongni Hou, Chunling Du, Yanping Cai and Junhua Zheng have contributed equally to this manuscript 1 Department of Pulmonary and Critical Care Medicine, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China 3 Infection Division, Wuhan Jin Yin-Tan Hospital, Wuhan, China Full list of author information is available at the end of the article © The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distr
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