Adverse Outcomes Associated With Corticosteroid Use in Critical COVID-19: A Retrospective Multicenter Cohort Study

Frontiers in Medicine

article

Yichen Li¹  Yibo Huang¹  Yifeng Zou¹  Ruixin Zhu²  Guangjun Yan³  Jie Li³  Jia Ke¹  Na Jiao¹  Lixin Zhu¹  Lihan Shen⁴  Lei Chen⁵  Zhiqiang Jiang⁶  Sijing Cheng¹ 

[1] The Sixth Affiliated Hospital, Sun Yat-sen University;Putuo People's Hospital, Department of Bioinformatics, Tongji University;The Third Clinical Medical College of Yangtze University, Jingzhou Hospital of Traditional Chinese Medicine;Department of Critical Care Medicine, Dongguan People's Hospital, Southern Medical University;Department of Critical Care Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University;School of Medicine, Sun Yat-sen University

关键词: SARS-CoV-2;    mortality;    critical;    gluocorticoid;    steroid;    COVID-19;    ARDS;    cytokine storm;   

DOI  :  10.3389/fmed.2021.604263

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Corticosteroid is commonly used to reduce damage from inflammatory reactions in coronavirus disease 2019 (COVID-19). We aim to determine the outcomes of corticosteroid use in critically ill COVID-19 patients. Ninety six critically ill patients, hospitalized in 14 hospitals outside Wuhan from January 16 to March 30, 2020 were enrolled in this study. Among 96 critical patients, 68 were treated with corticosteroid (CS group), while 28 were not treated with corticosteroids (non-CS group). Multivariable logistic regression were performed to determine the possible correlation between corticosteroid use and the treatment outcomes. Forty-six (68%) patients in the CS group died compared to six (21%) of the non-CS group. Corticosteroid use was also associated with the development of ARDS, exacerbation of pulmonary fibrosis, longer hospital stay and virus clearance time. On admission, no difference in laboratory findings between the CS and the non-CS group was observed. After corticosteroid treatment, patients treated with corticosteroids were associated with higher counts of white blood cells, neutrophils, neutrophil-to-lymphocyte ratio, alanine aminotransferase level and Sequential Organ Failure Assessment score. In conclusion, corticosteroid use in critically ill COVID-19 patients was associated with a much higher case fatality rate. Frequent incidence of liver injury and multi-organ failure in corticosteroid treated patients may have contributed to the adverse outcomes. The multi-organ failure is likely caused by more persistent SARS-CoV-2 infection and higher viral load, due to the inhibition of immune surveillance by corticosteroid.

【 授权许可】

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