1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study.
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Ewen M
Harrison
;
Nazir I
Lone
;
Steven
Kerr
;
Annemarie B
Docherty
;
Aziz
Sheikh
;
Matthew
Richardson
;
Omer
Elneima
;
Neil J
Greening
;
+63 more...
Victoria Claire
Harris
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Linzy
Houchen-Wolloff
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Hamish JC
McAuley
;
Ruth M
Saunders
;
Marco
Sereno
;
Aarti
Shikotra
;
Amisha
Singapuri
;
Raminder
Aul
;
Paul
Beirne
;
Charlotte E
Bolton
;
Jeremy S
Brown
;
Gourab
Choudhury
;
Nawar
Diar Bakerly
;
Nicholas
Easom
;
Carlos
Echevarria
;
Jonathan
Fuld
;
Nick
Hart
;
John R
Hurst
;
Mark
Jones
;
Dhruv
Parekh
;
Paul
Pfeffer
;
Najib M
Rahman
;
Sarah
Rowland-Jones
;
Ajay M
Shah
;
Dan G
Wootton
;
Caroline
Jolley
;
AA Roger
Thompson
;
Trudie
Chalder
;
Melanie J
Davies
;
Anthony
De Soyza
;
John R
Geddes
;
William
Greenhalf
;
Simon
Heller
;
Luke
Howard
;
Joseph
Jacob
;
R Gisli
Jenkins
;
Janet M
Lord
;
Will D-C
Man
;
Gerry P
McCann
;
Stefan
Neubauer
;
Peter JM
Openshaw
;
Joanna
Porter
;
Matthew J
Rowland
;
Janet T
Scott
;
Malcolm G
Semple
;
Sally J
Singh
;
David
Thomas
;
Mark
Toshner
;
Keir
Lewis
;
Liam G
Heaney
;
Andrew
Briggs
;
Bang
Zheng
;
Mathew
Thorpe
;
Jennifer K
Quint
;
James D
Chalmers
;
Ling-Pei
Ho
;
Alex
Horsley
;
Michael
Marks
;
Krisnah
Poinasamy
;
Betty
Raman
;
Louise V
Wain
;
Christopher E
Brightling
;
Rachael A
Evans
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(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.
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