1-Year Health Outcomes Associated with Systemic Corticosteroids for COVID-19: a Longitudinal Cohort Study.

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

ERJ open research（2024）

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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.

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