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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, Nirantharakumar K, Cheng K, Peng S, Xiao H. Systemic Corticosteroids and Mortality in Severe and Critical COVID-19 Patients in Wuhan, China. J Clin Endocrinol Metab 2020; 105:5900930. [PMID: 32880390 PMCID: PMC7499588 DOI: 10.1210/clinem/dgaa627] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023]
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.
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Affiliation(s)
- Jianfeng Wu
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Jianqiang Huang
- Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Guochao Zhu
- Department of Critical Care Medicine, The Affiliated Hospital of Jianghan University (No. Six Hospital of Wuhan), Wuhan, Hubei, People’s Republic of China
| | - Yihao Liu
- 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
| | - Han Xiao
- 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
| | - Qian Zhou
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xiang Si
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Hui Yi
- Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Cuiping Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Daya Yang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Shuling Chen
- 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
| | - Xin Liu
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Zelong Liu
- 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
| | - Qiongya Wang
- Department of Critical Care Medicine, Wuhan Hankou Hospital, Wuhan, Hubei, People’s Republic of China
| | - Qingquan Lv
- Department of Gastrointestinal Surgery, Wuhan Hankou Hospital, Wuhan, Hubei, People’s Republic of China
| | - Ying Huang
- Science and Education Section, Wuhan Hankou Hospital, Wuhan, Hubei, People’s Republic of China
| | - Yang Yu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Jianghan University (No. Six Hospital of Wuhan), Wuhan, Hubei, People’s Republic of China
| | - Xiangdong Guan
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, United Kingdom
- Health Data Research UK, United Kingdom
| | - KarKeung Cheng
- Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Sui Peng
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Corresponding author: Sui Peng, MD, Ph.D, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, No. 58, ZhongShan Road 2, Guangzhou, Guangdong 510080, People’s Republic of China, E-mail:
| | - Haipeng Xiao
- 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
- Corresponding author: Haipeng Xiao, MD, Ph.D, Department of Endocrinology & Precision Medicine Institute, The First Affiliated Hospital, Sun Yat-sen University, No. 58, ZhongShan Road 2, Guangzhou, Guangdong 510080, People’s Republic of China, E-mail:
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