Corticosteroid therapy in critically ill patients with COVID-19: a multicenter, retrospective study
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RESEARCH
Corticosteroid therapy in critically ill patients with COVID‑19: a multicenter, retrospective study Yiming Li1†, Qinghe Meng2†, Xin Rao1†, Binbin Wang1†, Xingguo Zhang3†, Fang Dong4†, Tao Yu5†, Zhongyi Li6, Huibin Feng7, Jinpeng Zhang8, Xiangyang Chen9, Hunian Li10, Yi Cheng11, Xiaoyang Hong12, Xiang Wang13, Yimei Yin14*, Zhongheng Zhang15* and Dawei Wang1*
Abstract Background: Corticoid therapy has been recommended in the treatment of critically ill patients with COVID-19, yet its efficacy is currently still under evaluation. We investigated the effect of corticosteroid treatment on 90-day mortality and SARS-CoV-2 RNA clearance in severe patients with COVID-19. Methods: 294 critically ill patients with COVID-19 were recruited between December 30, 2019 and February 19, 2020. Logistic regression, Cox proportional-hazards model and marginal structural modeling (MSM) were applied to evaluate the associations between corticosteroid use and corresponding outcome variables. Results: Out of the 294 critically ill patients affected by COVID-19, 183 (62.2%) received corticosteroids, with methylprednisolone as the most frequently administered corticosteroid (175 accounting for 96%). Of those treated with corticosteroids, 69.4% received corticosteroid prior to ICU admission. When adjustments and subgroup analysis were not performed, no significant associations between corticosteroids use and 90-day mortality or SARS-CoV-2 RNA clearance were found. However, when stratified analysis based on corticosteroid initiation time was performed, there was a significant correlation between corticosteroid use (≤ 3 day after ICU admission) and 90-day mortality (logistic regression adjusted for baseline: OR 4.49, 95% CI 1.17–17.25, p = 0.025; Cox adjusted for baseline and time varying variables: HR 3.89, 95% CI 1.94–7.82, p 26.2 pg/ml). Duration of SARS-CoV-2 RNA clearance was defined as the time from ICU admission until the occurrence of two negative Nucleic-acid Amplification tests (NAAT) without a positive test afterward. Corticosteroid therapy was
Li et al. Crit Care
(2020) 24:698
defined as the use of systemic corticosteroids when dosage equivalent to at least 60 mg of hydrocortisone per day [11]. The type, daily dose, and duration of corticosteroid administration were collected. All preparations were converted to hydrocortisone-equivalent doses (methylprednisolone 1:5, dexamethasone 1:25, prednisolone 1:4). Statistical analysis
Categorical variables were presented as frequency rates and percentages. Continuous variables were described using mean and standard deviations or medians and IQR values according to the distribution of the data. We compared characteristics of patients who received or not received corticosteroid therapy using chi-square test or Fisher’s exact test for categorical variables and student t-test or Mann–Whitney test for continuous variables, as appropriate. Subgroup analyses were performed by stratification to (1) high-dose corticosteroid therapy (≥ 300 mg of hydrocortisone equivale
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