Corticosteroid outcome may be dependent of duration of use in severe COVID-19open access
- Authors
- Kim, Jin Hyoung; Na, Yong Sub; Lee, Song-I; Moon, Youn Young; Hwang, Beom Seuk; Baek, Ae-Rin; Kim, Won Young; Lee, Bo Young; Seong, Gil Myeong; Baek, Moon Seong
- Issue Date
- May-2023
- Publisher
- KOREAN ASSOC INTERNAL MEDICINE
- Keywords
- COVID-19; Steroids; Oxygen inhalation therapy; Respiration; Artificial; Mortality
- Citation
- KOREAN JOURNAL OF INTERNAL MEDICINE, v.38, no.3, pp 382 - 392
- Pages
- 11
- Journal Title
- KOREAN JOURNAL OF INTERNAL MEDICINE
- Volume
- 38
- Number
- 3
- Start Page
- 382
- End Page
- 392
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/69499
- DOI
- 10.3904/kjim.2022.201
- ISSN
- 1226-3303
2005-6648
- Abstract
- Background/Aims: For patients hospitalized with coronavirus disease 2019 (COVID-19) who require supplemental oxygen, the evidence of the optimal duration of corticosteroid is limited. This study aims to identify whether long-term use of cortico-steroids is associated with decreased mortality.Methods: Between February 10, 2020 and October 31, 2021, we analyzed consecutive hospitalized patients with COVID-19 with severe hypoxemia. The patients were divided into short-term (<= 14 days) and long-term (> 14 days) corticosteroid users. The primary outcome was 60-day mortality. We performed propensity score (PS) analysis to mitigate the effect of confounders and conducted Kaplan-Meier curve analysis.Results: There were 141 (52%) short-term users and 130 (48%) long-term corticosteroid users. The median age was 68 years and the median PaO2/FiO2 at admission was 158. Of the patients, 40.6% required high-flow nasal cannula, 48.3% required mechanical ventilation, and 11.1% required extracorporeal membrane oxygenation. The overall 60-day mortality rate was 23.2%, and that of patients with hospital-acquired pneumonia (HAP) was 22.9%. The Kaplan-Meier curve for 60 day survival in the PS-matched cohort showed that corticosteroid for > 14 days was associated with decreased mortality (p = 0.0033). There were no significant differences in bacteremia and HAP between the groups. An adjusted odds ratio for the risk of 60-day mortality in short-term users was 5.53 (95% confidence interval, 1.90-18.26; p = 0.003).Conclusions: For patients with severe COVID-19, long-term use of corticosteroids was associated with decreased mortality, with no increase in nosocomial complications. Corticosteroid use for > 14 days can benefit patients with severe COVID-19.
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