1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study.
; Harrison, Ewen M; Lone, Nazir I; Kerr, Steven; Docherty, Annemarie B; Sheikh, Aziz; Richardson, Matthew; Elneima, Omer; Greening, Neil J; +63 more...Harris, Victoria Claire; Houchen-Wolloff, Linzy; McAuley, Hamish JC; Saunders, Ruth M; Sereno, Marco; Shikotra, Aarti; Singapuri, Amisha; Aul, Raminder; Beirne, Paul; Bolton, Charlotte E; Brown, Jeremy S; Choudhury, Gourab; Diar Bakerly, Nawar; Easom, Nicholas; Echevarria, Carlos; Fuld, Jonathan; Hart, Nick; Hurst, John R; Jones, Mark; Parekh, Dhruv; Pfeffer, Paul; Rahman, Najib M; Rowland-Jones, Sarah; Shah, Ajay M; Wootton, Dan G; Jolley, Caroline; Thompson, AA Roger; Chalder, Trudie; Davies, Melanie J; De Soyza, Anthony; Geddes, John R; Greenhalf, William; Heller, Simon; Howard, Luke; Jacob, Joseph; Jenkins, R Gisli; Lord, Janet M; Man, Will D-C; McCann, Gerry P; Neubauer, Stefan; Openshaw, Peter JM; Porter, Joanna; Rowland, Matthew J; Scott, Janet T; Semple, Malcolm G; Singh, Sally J; Thomas, David; Toshner, Mark; Lewis, Keir; Heaney, Liam G; Briggs, Andrew; Zheng, Bang; Thorpe, Mathew; Quint, Jennifer K; Chalmers, James D; Ho, Ling-Pei; Horsley, Alex; Marks, Michael; Poinasamy, Krisnah; Raman, Betty; Wain, Louise V; Brightling, Christopher E; and Evans, Rachael A
(2024)
1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study.
ERJ open research, 10 (5).
00474-2024.
ISSN 2312-0541
DOI: 10.1183/23120541.00474-2024
BACKGROUND: In patients with coronavirus disease 2019 (COVID-19) requiring supplemental oxygen, dexamethasone reduces acute severity and improves survival, but longer-term effects are unknown. We hypothesised that systemic corticosteroid administration during acute COVID-19 would be associated with improved health-related quality of life (HRQoL) 1 year after discharge. METHODS: Adults admitted to hospital between February 2020 and March 2021 for COVID-19 and meeting current guideline recommendations for dexamethasone treatment were included using two prospective UK cohort studies (Post-hospitalisation COVID-19 and the International Severe Acute Respiratory and emerging Infection Consortium). HRQoL, assessed by the EuroQol-Five Dimensions-Five Levels utility index (EQ-5D-5L UI), pre-hospital and 1 year after discharge were compared between those receiving corticosteroids or not after propensity weighting for treatment. Secondary outcomes included patient-reported recovery, physical and mental health status, and measures of organ impairment. Sensitivity analyses were undertaken to account for survival and selection bias. FINDINGS: Of the 1888 participants included in the primary analysis, 1149 received corticosteroids. There was no between-group difference in EQ-5D-5L UI at 1 year (mean difference 0.004, 95% CI -0.026-0.034). A similar reduction in EQ-5D-5L UI was seen at 1 year between corticosteroid exposed and nonexposed groups (mean±sd change -0.12±0.22 versus -0.11±0.22). Overall, there were no differences in secondary outcome measures. After sensitivity analyses modelled using a cohort of 109 318 patients admitted to hospital with COVID-19, EQ-5D-5L UI at 1 year remained similar between the two groups. INTERPRETATION: Systemic corticosteroids for acute COVID-19 have no impact on the large reduction in HRQoL 1 year after hospital discharge. Treatments to address the persistent reduction in HRQoL are urgently needed.
-
picture_as_pdf - Leavy-et-al-2024-1-year-health-outcomes-associated-with-systemic-corticosteroids-for-covid-19.pdf
-
subject - Published Version
-
- Available under Creative Commons: Attribution 4.0