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

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.

All Authors

Leavy, OC.

Russell, RJ.

Harrison, EM.

Lone, NI.

Kerr, S.

Docherty, AB.

Sheikh, A.

Richardson, M.

Elneima, O.

Greening, NJ.

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LTHT Author

Beirne, Paul

LTHT Department

Cardio-Respiratory
Respiratory Medicine

Publication Date

2024

Item Type

Journal Article

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.