Corticosteroids in patients hospitalized for COVID-19 pneumonia who require oxygen: observational comparative study using routine care data

• DOI: 10.1016/j.cmi.2020.11.035
• Publication Date: 2020-12-08T11:21:57Z
• Authors: Viet-Thi Tran; Matthieu Mahévas; Firouze Bani-Sadr; Olivier Robineau; Thomas Perpoint; Elodie Perrodeau; Laure Gallay; Philippe Ravaud; François Goehringer; François-Xavier L...; François-Xavier L...; Viet-Thi Tran; Matthieu Mahévas; Firouze Bani-Sadr; Olivier Robineau; Thomas Perpoint; Elodie Perrodeau; Laure Gallay; Philippe Ravaud; François Goehringer; François-Xavier L...; François-Xavier L...; Laure Gallay; Matthieu Mahévas; Viet-Thi Tran; Viet-Thi Tran; Elodie Perrodeau; Philippe Ravaud; Sophie Ismaël; François Goehringer; François-Xavier L...; Matthieu Mahévas; Thomas Perpoint; Viet-Thi Tran; François-Xavier L...; Cédric Laouénan; Jennifer Soulier; Oriane Puéchal; Eric D’Ortenzio; Yazdan Yazdanpanah; Laurence Maulin; Stéphanie Martinez; Diane Sanderink; Pascale Fialaire; Séverine Ansart; Lucas Perez; Anne - Laure Destrem; Chloé Moulin; Pascal Gicquel; Frédéric Rivière; Martin Martinot; Mahsa Mohseni Zadeh; Tomasz Chroboczek; Thibaut Challan B...; Lionel Piroth; Thibault Sixt; Florian Moretto; André Cabié; Jérémie Pasquier; Ornella Cabras; Marine Morrier; Jean Reuter; Thomas Henin; Pierre Braquet; Helene Desmurs-Cl...; Arnaud Hot; Thomas Perpoint; Boris Bienvenu; Belkacem Asselate; Nicolas Vignier; Steve Nguala; Sylvain Diamantis; Guillemette Frémont; Pierre Louis Nivose; Mathilde Thiébaut; François Goehringer; Benjamin Lefevre; Hélène Auge; Paul le Turnier; Naila Benkalfate; Olivier Grossi; Samuel Pineau; Elisa Demonchy; Julie Merindol; Claire Durand; Nathalie Tieulié; Viviane Queyrel; Didier Laureillard; Paul Loubet; Ségolène Greffe; Nathalie Dournon; Youssouf Mohamed ...; Cyrille Gourjault; Alexandre Lahens; François-Xavier L...; Paul Legendre; Caroline Morbieu; Matthieu Mahevas; Giovanna Melica; Jean-Daniel Levièvre; Frédéric Schlemmer; Simone Tunesi; Claire Leblanc; Anne Bourgarit-Du...; Alexandre Bleibtreu; Gianpiero Tebano; Jérôme Pacanowski; Jean-Benoit Zabbe; Mathilde Devaux; Laurent Bellec; Marine Gosset-Woi...; Céleste Lambert; Firouze Bani-Sadr; Maxime Hentzien; Amélie Servettaz; Kevin Alexandre; Manuel Etienne; Romain Leguillon; Marion Dollat; Rémi Lefrancois; Anne Pouvaret; Yvon Ruch; Yannick Dieudonné; Guillaume Martin-...; Xavier Boumaza; Margaux Lafaurie; Olivier Robineau; Macha Tetart; Adrien Lemaignen; Nicole Ferreira-M...; Amélie Duréault; Marie Gousseff; Claire Chantepie; Francesca Bisio; Fanny Pommeret; Emeline Colomba B...; Claire Ara Somohano
• Keywords: Microbiology (medical); Adult; Male; 0301 basic medicine; Adolescent; Therapeutic evaluation; [SDV]Life Sciences [q-bio]; 610; Severity of Illness Index; Young Adult; 03 medical and health sciences; Adrenal Cortex Hormones; Observational study; 616; Corticosteroids; Humans; Aged; Aged, 80 and over; Oxygen Inhalation Therapy; COVID-19; General Medicine; Middle Aged; Respiration, Artificial; COVID-19 Drug Treatment; 3. Good health; [SDV] Life Sciences [q-bio]; Infectious Diseases; C-Reactive Protein; Prednisone; Original Article; Female; Causal inference

To assess the effectiveness of corticosteroids on outcomes of patients with coronavirus disease 2019 (COVID-19) pneumonia requiring oxygen without mechanical ventilation.We used routine care data from 51 hospitals in France and Luxembourg to assess the effectiveness of corticosteroids at 0.8 mg/kg/day eq. prednisone (CTC group) versus standard of care (no-CTC group) among adults 18-80 years old with confirmed COVID-19 pneumonia requiring oxygen without mechanical ventilation. The primary outcome was intubation or death by day 28. In our main analysis, characteristics of patients at baseline (i.e. time when patients met all inclusion criteria) were balanced by using propensity-score inverse probability of treatment weighting.Among the 891 patients included in the analysis, 203 were assigned to the CTC group. Use of corticosteroids was not significantly associated with risk of intubation or death by day 28 (weighted hazard ratio (wHR) 0.92, 95%CI 0.61-1.39) nor cumulative death rate (wHR 1.03, 95%CI 0.54-1.98). However, use of corticosteroids was associated with reduced risk of intubation or death by day 28 in the prespecified subgroups of patients requiring oxygen ≥3 L/min (wHR 0.50, 95%CI 0.30-0.85) or C-reactive protein level ≥100 mg/L (wHR 0.44, 95%CI 0.23-0.85). The number of hyperglycaemia events was higher for patients with corticosteroids than for those without, but the number of infections was similar.We found no association between the use of corticosteroids and intubation or death in the broad population of patients 18-80 years old, with COVID-19, hospitalized in settings non intensive care units. However, the treatment was associated with a reduced risk of intubation or death for patients with ≥3 L/min oxygen or C-reactive protein level ≥100 mg/L at baseline. Further research is needed to confirm the right timing for corticosteroids in patients with COVID-19 requiring oxygen only.