Corticosteroids are associated with increased survival in elderly presenting severe SARS-Cov2 infection

Objective

To assess the effectiveness of corticosteroids among elderly patients with COVID-19 pneumonia requiring oxygen.

Design

Comparative observational study based on routine care data. Baseline characteristics of patients were balanced using propensity-score inverse probability of treatment weighting.

Setting

Geriatric and infectious diseases wards from 36 hospitals in France and Luxembourg.

Participants

Adults > 80 years old PCR confirmed SARS-CoV-2 infection or typical CT-scan images, requiring oxygen ≥ 3L/min and with an inflammatory syndrome (C-reactive protein ≥ 40mg/L).

Measurements

The primary outcome was overall survival at day 14. The secondary outcome was the proportion of patients discharged from hospital to home/rehabilitation on day 14. Adverse events were abstracted from electronic health records.

Results

Among the 267 patients included in the analysis, 96 were assigned to the treatment group. Median age was 86, interquartile range 83 to 90 and 95% had a SARS-CoV-2 PCR-confirmed diagnosis. Use of corticosteroids was significantly associated with an increased survival (weighted hazard ratio [wHR] 0.66, 95% CI 0.44 to 0.97). There was no significant difference between the treatment and control groups regarding the proportion of patients discharged to home/rehabilitation at day 14 (wRR 1.11, 95% CI 0.68 to 1.81). Twenty-two (16.7%) patients receiving corticosteroids developed adverse events while only 11 (6.4%) from the control group did.

Conclusions

Corticosteroids were associated with a significant increase the day-14 overall survival of patients over 80 years old hospitalized for severe COVID-19.

Impact statement

We certify that this work is novel. As of today, studies on the efficacy of corticosteroids did not specifically target elderly patients.

Among older patients aged over 80 years old, the RECOVERY trial found no difference in the survival of patients treated or not with dexamethasone. However, the heterogeneity in the severity of infection within the latter subgroup limited the drawing of strong conclusions