Tags

Type your tag names separated by a space and hit enter

Systemic Corticosteroids and Mortality in Severe and Critical COVID-19 Patients in Wuhan, China.
J Clin Endocrinol Metab. 2020 12 01; 105(12)JC

Abstract

BACKGROUND

Systemic corticosteroids are now recommended in many treatment guidelines, although supporting evidence is limited to 1 randomized controlled clinical trial (RECOVERY).

OBJECTIVE

To identify whether corticosteroids were beneficial to COVID-19 patients.

METHODS

A total of 1514 severe and 249 critical hospitalized COVID-19 patients from 2 medical centers in Wuhan, China. Multivariable Cox models, Cox model with time-varying exposure and propensity score analysis (inverse-probability-of-treatment-weighting [IPTW] and propensity score matching [PSM]) were used to estimate the association of corticosteroid use with risk of in-hospital mortality in severe and critical cases.

RESULTS

Corticosteroids were administered in 531 (35.1%) severe and 159 (63.9%) critical patients. Compared to the non-corticosteroid group, systemic corticosteroid use was not associated with beneficial effect in reducing in-hospital mortality in either severe cases (HR = 1.77; 95% CI, 1.08-2.89; P = 0.023), or critical cases (HR = 2.07; 95% CI, 1.08-3.98; P = 0.028). Findings were similar in time-varying Cox analysis. For patients with severe COVID-19 at admission, corticosteroid use was not associated with improved or harmful outcome in either PSM or IPTW analysis. For critical COVID-19 patients at admission, results were consistent with multivariable Cox model analysis.

CONCLUSION

Corticosteroid use was not associated with beneficial effect in reducing in-hospital mortality for severe or critical cases in Wuhan. Absence of the beneficial effect in our study in contrast to that observed in the RECOVERY clinical trial may be due to biases in observational data, in particular prescription by indication bias, differences in clinical characteristics of patients, choice of corticosteroid used, timing of initiation of treatment, and duration of treatment.

Authors+Show Affiliations

Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.Department of Critical Care Medicine, The Affiliated Hospital of Jianghan University (No. Six Hospital of Wuhan), Wuhan, Hubei, People's Republic of China.Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China. Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.Department of Critical Care Medicine, Wuhan Hankou Hospital, Wuhan, Hubei, People's Republic of China.Department of Gastrointestinal Surgery, Wuhan Hankou Hospital, Wuhan, Hubei, People's Republic of China.Science and Education Section, Wuhan Hankou Hospital, Wuhan, Hubei, People's Republic of China.Department of Gastrointestinal Surgery, The Affiliated Hospital of Jianghan University (No. Six Hospital of Wuhan), Wuhan, Hubei, People's Republic of China.Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.Institute of Applied Health Research, University of Birmingham, United Kingdom. Health Data Research UK, United Kingdom.Institute of Applied Health Research, University of Birmingham, United Kingdom.Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China. Precision Medicine Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32880390

Citation

Wu, Jianfeng, et al. "Systemic Corticosteroids and Mortality in Severe and Critical COVID-19 Patients in Wuhan, China." The Journal of Clinical Endocrinology and Metabolism, vol. 105, no. 12, 2020.
Wu J, Huang J, Zhu G, et al. Systemic Corticosteroids and Mortality in Severe and Critical COVID-19 Patients in Wuhan, China. J Clin Endocrinol Metab. 2020;105(12).
Wu, J., Huang, J., Zhu, G., Liu, Y., Xiao, H., Zhou, Q., Si, X., Yi, H., Wang, C., Yang, D., Chen, S., Liu, X., Liu, Z., Wang, Q., Lv, Q., Huang, Y., Yu, Y., Guan, X., Li, Y., ... Xiao, H. (2020). Systemic Corticosteroids and Mortality in Severe and Critical COVID-19 Patients in Wuhan, China. The Journal of Clinical Endocrinology and Metabolism, 105(12). https://doi.org/10.1210/clinem/dgaa627
Wu J, et al. Systemic Corticosteroids and Mortality in Severe and Critical COVID-19 Patients in Wuhan, China. J Clin Endocrinol Metab. 2020 12 1;105(12) PubMed PMID: 32880390.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systemic Corticosteroids and Mortality in Severe and Critical COVID-19 Patients in Wuhan, China. AU - Wu,Jianfeng, AU - Huang,Jianqiang, AU - Zhu,Guochao, AU - Liu,Yihao, AU - Xiao,Han, AU - Zhou,Qian, AU - Si,Xiang, AU - Yi,Hui, AU - Wang,Cuiping, AU - Yang,Daya, AU - Chen,Shuling, AU - Liu,Xin, AU - Liu,Zelong, AU - Wang,Qiongya, AU - Lv,Qingquan, AU - Huang,Ying, AU - Yu,Yang, AU - Guan,Xiangdong, AU - Li,Yanbing, AU - Nirantharakumar,Krishnarajah, AU - Cheng,KarKeung, AU - Peng,Sui, AU - Xiao,Haipeng, PY - 2020/06/08/received PY - 2020/09/01/accepted PY - 2020/9/4/pubmed PY - 2020/10/21/medline PY - 2020/9/4/entrez KW - COVID-19 KW - mortality KW - severe and critical KW - systemic corticosteroids JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 105 IS - 12 N2 - BACKGROUND: Systemic corticosteroids are now recommended in many treatment guidelines, although supporting evidence is limited to 1 randomized controlled clinical trial (RECOVERY). OBJECTIVE: To identify whether corticosteroids were beneficial to COVID-19 patients. METHODS: A total of 1514 severe and 249 critical hospitalized COVID-19 patients from 2 medical centers in Wuhan, China. Multivariable Cox models, Cox model with time-varying exposure and propensity score analysis (inverse-probability-of-treatment-weighting [IPTW] and propensity score matching [PSM]) were used to estimate the association of corticosteroid use with risk of in-hospital mortality in severe and critical cases. RESULTS: Corticosteroids were administered in 531 (35.1%) severe and 159 (63.9%) critical patients. Compared to the non-corticosteroid group, systemic corticosteroid use was not associated with beneficial effect in reducing in-hospital mortality in either severe cases (HR = 1.77; 95% CI, 1.08-2.89; P = 0.023), or critical cases (HR = 2.07; 95% CI, 1.08-3.98; P = 0.028). Findings were similar in time-varying Cox analysis. For patients with severe COVID-19 at admission, corticosteroid use was not associated with improved or harmful outcome in either PSM or IPTW analysis. For critical COVID-19 patients at admission, results were consistent with multivariable Cox model analysis. CONCLUSION: Corticosteroid use was not associated with beneficial effect in reducing in-hospital mortality for severe or critical cases in Wuhan. Absence of the beneficial effect in our study in contrast to that observed in the RECOVERY clinical trial may be due to biases in observational data, in particular prescription by indication bias, differences in clinical characteristics of patients, choice of corticosteroid used, timing of initiation of treatment, and duration of treatment. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/32880390/Systemic_Corticosteroids_and_Mortality_in_Severe_and_Critical_COVID_19_Patients_in_Wuhan_China_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/clinem/dgaa627 DB - PRIME DP - Unbound Medicine ER -