Systemic corticosteroids show no benefit in severe and critical COVID 19 patients in Wuhan, China: A retrospective cohort study
Background: Systemic corticosteroids are recommended by some treatment guidelines and used in severe and critical COVID 19 patients, though evidence supporting such use is limited. Methods: From December 26, 2019 to March 15, 2020, 1514 severe and 249 critical hospitalized COVID 19 patients were collected from two medical centers in Wuhan, China. We performed multivariable Cox models, Cox model with time varying exposure and propensity score analysis (both inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) to estimate the association of corticosteroid use with the risk of in hospital mortality among severe and critical cases. Results: Corticosteroids were administered in 531 (35.1% severe and 159 (63.9% critical patients. Compared to no corticosteroid use group, systemic corticosteroid use showed no benefit in reducing in hospital mortality in both severe cases (HR=1.77, 95% CI: 1.08 2.89, p=0.023) and critical cases (HR=2.07, 95% CI: 1.08 3.98, p=0.028) In the time varying Cox analysis that with time varying exposure, systemic corticosteroid use still showed no benefit in either population (for severe patients, HR=2.83, 95% CI: 1.72 4.64, p< 0.001; for critical patients, HR=3.02, 95% CI: 1.59 5.73, p=0.001) Baseline characteristics were matched after IPTW and PSM analysis. For severe COVID 19 patients at admission, corticosteroid use was not associated with improved outcome in either the IPTW analysis. For critical COVID 19 patients at admission, results were consistent with former analysis that corticosteroid use did not reduce in hospital mortality. Conclusions: Corticosteroid use showed no benefit in reducing in hospital mortality for severe or critical cases. The routine use of systemic corticosteroids among severe and critical COVID 19 patients was not recommended.
medRxiv