Beneficial effect of corticosteroids in severe COVID-19 pneumonia: a propensity score matching analysis

  1. Tomasz Chroboczek
  2. Marie Lacoste
  3. Chloe Wackenheim
  4. Thibaut Challan-Belval
  5. Benjamin Amar
  6. Thomas Boisson
  7. Jason Hubac
  8. Dominique Leduc
  9. Colleen Masse
  10. Victor Dechaene
  11. Laetitia Touhiri-Maximin
  12. Sandrine Megessier
  13. Camille Lassale

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Abstract

Background

Since December 2019, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), responsible for Coronavirus Disease 2019 (COVID-19), is spreading worldwide, causing significant morbidity and mortality. No specific treatment has yet clearly shown to improve the disease’s evolution. Validated therapeutic options are urgently needed.

Methods

In this retrospective study, we aimed to evaluate determinants of the prognosis of the disease in 70 patients with COVID-19 severe pneumonia (i.e. requiring at least 3 liters of oxygen) hospitalized between 10 March and 9 April, 2020, in the Centre Hospitalier Alpes Léman, France. The main outcome was oro-tracheal intubation and the exposure of interest was corticotherapy. Since this was not a randomized trial, we used propensity score matching to estimate average treatment effect.

Results

There was evidence that corticotherapy lowered the risk of intubation with a risk difference of −47.1% (95% confidence interval −71.8% to −22.5%).

Conclusion

Corticosteroid, a well-known, easily available, and cheap treatment, could be an important tool in management of severe COVID-19 patients with respiratory failure. Not only could it provide an individual benefit, but also, in the setting of the COVID-19 ongoing pandemic, lower the burden on our vulnerable healthcare systems.

Key points

By propensity score matching analysis, the average treatment effect of corticosteroids on 70 patients with severe COVID-19 pneumonia was estimated. Corticosteroid therapy lowered the risk of intubation with a risk difference of −47.1% (95% confidence interval −71.8% to −22.5%).

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  1. ScreenIT

    SciScore for 10.1101/2020.05.08.20094755: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study received approval from the local Ethics Committee of the Centre Hospitalier Alpes Léman.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analyses were performed with the Stata version 15.1 program (StataCorp, College Station, TX).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study presents numerous limitations, notably those that are inherent to its retrospective nature. Nonetheless, we tried to clarify the role of corticosteroids on the disease’s evolution by building a propensity score, and thus limit confounding due to prescription bias. Also, we chose to consider and investigate all patients hospitalized for COVID-19 in our institution, to limit the selection bias; however, this could have induced prescription bias, since not all the hospital units had the same prescription practice. We did not notice any serious adverse effect of corticosteroid therapy in our study, but it is worth noting that long-term effects cannot be investigated at this time. This should be the object of further studies. In conclusion, we believe that corticosteroid, a well-known, easily available, and cheap treatment, could be an important tool for the management of severe COVID-19 patients with respiratory failure. Not only could it provide an individual benefit, but also, in the context of the current COVID-19 pandemic, lower the burden on our vulnerable healthcare systems.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.05.08.20094755 on medRxiv