1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study

Leavy, Olivia C; Russell, Richard J; Harrison, Ewen M; Lone, Nazir I; Kerr, Steven; Docherty, Annemarie B; Sheikh, Aziz; Richardson, Matthew; Elneima, Omer; Greening, Neil J; Harris, Victoria Claire; Houchen-Wolloff, Linzy; McAuley, Hamish J C; 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, A A 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 J M; 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; Evans, Rachael A

Author

Leavy, Olivia C
Russell, Richard J
Harrison, Ewen M
Lone, Nazir I
Kerr, Steven
Docherty, Annemarie B
Sheikh, Aziz
Richardson, Matthew
Elneima, Omer
Greening, Neil J

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Publication date

2024-09-30

Subject

Respiratory medicine

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Abstract

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.

Citation

Leavy OC, Russell RJ, Harrison EM, Lone NI, Kerr S, Docherty AB, Sheikh A, Richardson M, Elneima O, Greening NJ, Harris VC, Houchen-Wolloff L, McAuley HJC, Saunders RM, Sereno M, Shikotra A, Singapuri A, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst JR, Jones M, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones S, Shah AM, Wootton DG, Jolley C, Thompson AAR, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Heller S, Howard L, Jacob J, Jenkins RG, Lord JM, Man WD, McCann GP, Neubauer S, Openshaw PJM, Porter J, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas D, Toshner M, Lewis K, Heaney LG, Briggs A, Zheng B, Thorpe M, Quint JK, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Wain LV, Brightling CE, Evans RA. 1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study. ERJ Open Res. 2024 Sep 30;10(5):00474-2024. doi: 10.1183/23120541.00474-2024.

Type

Article