Corticosteroids for hospitalized patients with mild to critically-ill COVID-19: a multicenter, retrospective, propensity score-matched study

Satoshi Ikeda, Toshihiro Misumi, Shinyu Izumi, Keita Sakamoto, Naoki Nishimura, Shosei Ro, Koichi Fukunaga, Satoshi Okamori, Natsuo Tachikawa, Nobuyuki Miyata, Masaharu Shinkai, Masahiro Shinoda, Yasunari Miyazaki, Yuki Iijima, Takehiro Izumo, Minoru Inomata, Masaki Okamoto, Tomoyoshi Yamaguchi, Keisuke Iwabuchi, Makoto MasudaHiroyuki Takoi, Yoshitaka Oyamada, Shigeki Fujitani, Masamichi Mineshita, Haruyuki Ishii, Atsushi Nakagawa, Nobuhiro Yamaguchi, Makoto Hibino, Kenji Tsushima, Tatsuya Nagai, Satoru Ishikawa, Nobuhisa Ishikawa, Yasuhiro Kondoh, Yoshitaka Yamazaki, Kyoko Gocho, Tomotaka Nishizawa, Akifumi Tsuzuku, Kazuma Yagi, Yuichiro Shindo, Yuriko Takeda, Takeharu Yamanaka, Takashi Ogura

Research output: Contribution to journalArticlepeer-review

Abstract

Corticosteroids use in coronavirus disease 2019 (COVID-19) is controversial, especially in mild to severe patients who do not require invasive/noninvasive ventilation. Moreover, many factors remain unclear regarding the appropriate use of corticosteroids for COVID-19. In this context, this multicenter, retrospective, propensity score–matched study was launched to evaluate the efficacy of systemic corticosteroid administration for hospitalized patients with COVID-19 ranging in the degree of severity from mild to critically-ill disease. This multicenter, retrospective study enrolled consecutive hospitalized COVID-19 patients diagnosed January–April 2020 across 30 institutions in Japan. Clinical outcomes were compared for COVID-19 patients who received or did not receive corticosteroids, after adjusting for propensity scores. The primary endpoint was the odds ratio (OR) for improvement on a 7-point ordinal score on Day 15. Of 1092 COVID-19 patients analyzed, 118 patients were assigned to either the corticosteroid and non-corticosteroid group, after propensity score matching. At baseline, most patients did not require invasive/noninvasive ventilation (85.6% corticosteroid group vs. 89.8% non-corticosteroid group). The odds of improvement in a 7-point ordinal score on Day 15 was significantly lower for the corticosteroid versus non-corticosteroid group (OR, 0.611; 95% confidence interval [CI], 0.388–0.962; p = 0.034). The time to improvement in radiological findings was significantly shorter in the corticosteroid versus non-corticosteroid group (hazard ratio [HR], 1.758; 95% CI, 1.323–2.337; p < 0.001), regardless of baseline clinical status. The duration of invasive mechanical ventilation was shorter in corticosteroid versus non-corticosteroid group (HR, 1.466; 95% CI, 0.841–2.554; p = 0.177). Of the 106 patients who received methylprednisolone, the duration of invasive mechanical ventilation was significantly shorter in the pulse/semi-pulse versus standard dose group (HR, 2.831; 95% CI, 1.347–5.950; p = 0.006). In conclusion, corticosteroids for hospitalized patients with COVID-19 did not improve clinical status on Day 15, but reduced the time to improvement in radiological findings for all patients regardless of disease severity and also reduced the duration of invasive mechanical ventilation in patients who required intubation. Trial registration: This study was registered in the University hospital Medical Information Network Clinical Trials Registry on April 21, 2020 (ID: UMIN000040211).

Original languageEnglish
Article number10727
JournalScientific reports
Volume11
Issue number1
DOIs
Publication statusPublished - 2021 Dec
Externally publishedYes

ASJC Scopus subject areas

  • General

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