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

Abstract

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.

Keywords: ARDS; COVID-19; SARS-CoV-2; critical; cytokine storm; gluocorticoid; mortality; steroid.

Figure 1

Study flow diagram. Medical records of COVID-19 patients (106 non-critically ill and 96 critically ill) included for the study of the corticosteroid effects were accessed from Jingzhou Hospital of Traditional Chinese Medicine (61 cases), Jianli Hospital of Traditional Chinese Medicine (44), Jingzhou First Hospital (9 cases), Jingzhou Central Hospital (29 cases), Jingzhou First People's Hospital (11 cases), Jingzhou Chest Hospital (9 cases), Gongan People's Hospital (8 cases), Honghu People's Hospital (10 cases), Honghu Hospital for the Control of Schistosomiasis (3 cases), Honghu Central Hospital (2 cases), Jianli People's Hospital (3 cases), Jiangling People's Hospital (2 cases), Shishou Hospital of Traditional Chinese Medicine (5 cases), and Songzi People's Hospital (6 cases).