Association between corticosteroids and intubation or death among patients with COVID-19 pneumonia in non-ICU settings: an observational study using of real-world data from 51 hospitals in France and Luxembourg

  1. The COCORICO Collaborative Group
  2. Viet-Thi Tran
  3. Matthieu Mahévas
  4. Firouze Bani-Sadr
  5. Olivier Robineau
  6. Thomas Perpoint
  7. Elodie Perrodeau
  8. Laure Gallay
  9. Philippe Ravaud
  10. François Goehringer
  11. François-Xavier Lescure
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Abstract

Objective

To assess the effectiveness of corticosteroids on outcomes of patients with mild COVID-19 pneumonia.

Methods

We used routine care data from 51 hospitals in France and Luxembourg to assess the effectiveness of corticosteroids at 0.8 mg/kg/day eq. prednisone (CTC group) vs standard of care (no-CTC group) among patients ≤ 80 years old with COVID-19 pneumonia requiring oxygen without mechanical ventilation. The primary outcome was intubation or death at Day 28. Baseline characteristics of patients were balanced using propensity score inverse probability of treatment weighting.

Results

Among the 891 patients included in the analysis, 203 were assigned to the CTC group. At day 28, corticosteroids did not reduce the rate of the primary outcome (wHR 0.92, 95% CI 0.61 to 1.39) nor the cumulative death rate (wHR 1.03, 95% CI 0.54 to 1.98). Corticosteroids significantly reduced the rate of the primary outcome for patients requiring oxygen ≥ at 3L/min (wHR 0.50, 95% CI 0.30 to 0.85) or C-Reactive Protein (CRP) ≥ 100mg/L (wHR 0.44, 95%CI 0.23 to 0.85). We found a higher number of hyperglycaemia events among patients who received corticosteroids, but number of infections were similar across the two groups.

Conclusions

We found no association between the use of corticosteroids and intubation or death in the broad population of patients ≤80 years old with COVID-19 hospitalized in non-ICU settings. However, the treatment was beneficial for patients with ≥ 3L/min oxygen or CRP ≥ 100mg/L at baseline. These data support the need to confirm the right timing of corticosteroids for patients with mild COVID.

Short summary

We assessed the effectiveness of corticosteroids among patients ≤ 80 years old with COVID-19, in non-ICU settings. Our results support the use of corticosteroids for patients receiving oxygen at ≥3L/min or with a C-reactive protein ≥ 100mg/L at baseline.

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