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Effectiveness of Systemic Corticosteroids Therapy for Nonsevere Patients With COVID-19: A Multicenter, Retrospective, Longitudinal Cohort Study
OBJECTIVES: Corticosteroids were clinically used in the treatment of nonsevere patients with COVID-19, but the efficacy of such treatment lacked sufficient clinical evidence, and the impact of dose had never been studied. This study aimed to evaluate the effect of systemic corticosteroid use (SCU) i...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8866099/ https://www.ncbi.nlm.nih.gov/pubmed/35219601 http://dx.doi.org/10.1016/j.jval.2021.12.013 |
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author | Chen, Zhenyuan Yin, Xiaoxv Tan, Xiangping Wang, Jing Jiang, Nan Tian, Mengge Li, Hui Lu, Zuxun Xiong, Nian Gong, Yanhong |
author_facet | Chen, Zhenyuan Yin, Xiaoxv Tan, Xiangping Wang, Jing Jiang, Nan Tian, Mengge Li, Hui Lu, Zuxun Xiong, Nian Gong, Yanhong |
author_sort | Chen, Zhenyuan |
collection | PubMed |
description | OBJECTIVES: Corticosteroids were clinically used in the treatment of nonsevere patients with COVID-19, but the efficacy of such treatment lacked sufficient clinical evidence, and the impact of dose had never been studied. This study aimed to evaluate the effect of systemic corticosteroid use (SCU) in nonsevere patients with COVID-19. METHODS: We conducted a multicenter retrospective cohort study in Hubei Province. A total of 1726 patients admitted with nonsevere type COVID-19 were included. Mixed-effect Cox model, mixed-effect Cox model with time-varying exposure, multiple linear regression, and propensity score analysis (inverse probability of treatment weight and propensity score matching) were used to explore the association between SCU and progression into severe type, all-cause mortality, and length of stay. RESULTS: During the follow-up of 30 days, 29.8% of nonsevere patients with COVID-19 received treatment with systemic corticosteroids. The use of systemic corticosteroids was associated with higher probability of developing severe type (adjusted hazard ratio 1.81; 95% confidence interval 1.47-2.21), all-cause mortality (adjusted hazard ratio 2.92; 95% confidence interval 1.39-6.15) in time-varying Cox analysis, and prolonged hospitalization (β 4.14; P < .001) in multiple linear regression. Analysis with 2 propensity score cohorts displayed similar results. Besides, increased corticosteroid dose was significantly associated with elevated probability of developing severe type (P < .001) and prolonged hospitalization (P < .001). CONCLUSIONS: Corticosteroid treatment against nonsevere patients with COVID-19 was significantly associated with worse clinical outcomes. The higher dose was significantly associated with elevated risk of poor disease progression. We recommend that SCU should be avoided unless necessary among nonsevere patients with COVID-19. |
format | Online Article Text |
id | pubmed-8866099 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-88660992022-02-24 Effectiveness of Systemic Corticosteroids Therapy for Nonsevere Patients With COVID-19: A Multicenter, Retrospective, Longitudinal Cohort Study Chen, Zhenyuan Yin, Xiaoxv Tan, Xiangping Wang, Jing Jiang, Nan Tian, Mengge Li, Hui Lu, Zuxun Xiong, Nian Gong, Yanhong Value Health Themed Section: COVID-19 OBJECTIVES: Corticosteroids were clinically used in the treatment of nonsevere patients with COVID-19, but the efficacy of such treatment lacked sufficient clinical evidence, and the impact of dose had never been studied. This study aimed to evaluate the effect of systemic corticosteroid use (SCU) in nonsevere patients with COVID-19. METHODS: We conducted a multicenter retrospective cohort study in Hubei Province. A total of 1726 patients admitted with nonsevere type COVID-19 were included. Mixed-effect Cox model, mixed-effect Cox model with time-varying exposure, multiple linear regression, and propensity score analysis (inverse probability of treatment weight and propensity score matching) were used to explore the association between SCU and progression into severe type, all-cause mortality, and length of stay. RESULTS: During the follow-up of 30 days, 29.8% of nonsevere patients with COVID-19 received treatment with systemic corticosteroids. The use of systemic corticosteroids was associated with higher probability of developing severe type (adjusted hazard ratio 1.81; 95% confidence interval 1.47-2.21), all-cause mortality (adjusted hazard ratio 2.92; 95% confidence interval 1.39-6.15) in time-varying Cox analysis, and prolonged hospitalization (β 4.14; P < .001) in multiple linear regression. Analysis with 2 propensity score cohorts displayed similar results. Besides, increased corticosteroid dose was significantly associated with elevated probability of developing severe type (P < .001) and prolonged hospitalization (P < .001). CONCLUSIONS: Corticosteroid treatment against nonsevere patients with COVID-19 was significantly associated with worse clinical outcomes. The higher dose was significantly associated with elevated risk of poor disease progression. We recommend that SCU should be avoided unless necessary among nonsevere patients with COVID-19. International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc. 2022-05 2022-02-24 /pmc/articles/PMC8866099/ /pubmed/35219601 http://dx.doi.org/10.1016/j.jval.2021.12.013 Text en © 2022 International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Themed Section: COVID-19 Chen, Zhenyuan Yin, Xiaoxv Tan, Xiangping Wang, Jing Jiang, Nan Tian, Mengge Li, Hui Lu, Zuxun Xiong, Nian Gong, Yanhong Effectiveness of Systemic Corticosteroids Therapy for Nonsevere Patients With COVID-19: A Multicenter, Retrospective, Longitudinal Cohort Study |
title | Effectiveness of Systemic Corticosteroids Therapy for Nonsevere Patients With COVID-19: A Multicenter, Retrospective, Longitudinal Cohort Study |
title_full | Effectiveness of Systemic Corticosteroids Therapy for Nonsevere Patients With COVID-19: A Multicenter, Retrospective, Longitudinal Cohort Study |
title_fullStr | Effectiveness of Systemic Corticosteroids Therapy for Nonsevere Patients With COVID-19: A Multicenter, Retrospective, Longitudinal Cohort Study |
title_full_unstemmed | Effectiveness of Systemic Corticosteroids Therapy for Nonsevere Patients With COVID-19: A Multicenter, Retrospective, Longitudinal Cohort Study |
title_short | Effectiveness of Systemic Corticosteroids Therapy for Nonsevere Patients With COVID-19: A Multicenter, Retrospective, Longitudinal Cohort Study |
title_sort | effectiveness of systemic corticosteroids therapy for nonsevere patients with covid-19: a multicenter, retrospective, longitudinal cohort study |
topic | Themed Section: COVID-19 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8866099/ https://www.ncbi.nlm.nih.gov/pubmed/35219601 http://dx.doi.org/10.1016/j.jval.2021.12.013 |
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