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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  1. ScreenIT

    SciScore for 10.1101/2020.09.16.20195750: (What is this?)

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

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and Limitations of study: One of the major strengths of this study is the analysis of a large number of consecutive patients, from a broad variety of centres in France and Luxembourg. Another strength is that all safety data have been reviewed in double and independently by several clinicians which did not note any warning signal for using corticosteroids in COVID-19 pneumonia in terms of secondary bacterial or fungal infection, even for ventilator-associated pneumonia. In terms of adverse events, there were only a higher number of hyperglycaemia occurrences in patients treated by corticosteroids which are usually transient and reversible with the stoppage of the steroids. However, our study has several limitations. First, despite the use of robust methods and statistical techniques to draw causal inferences. our study is observational, and potential unmeasured confounders may bias our results. Second, our study used real world data, with a heterogeneity in the prescription of corticosteroids treatment in terms of drugs, time of start, dose and duration. Third, we were not able to analyse the impact of the duration of corticoid prescription as we dealt with observational data collected from routine care. For example, some patients only received three days of corticosteroids because an event occurred on the fourth day. Only trials where the dose and duration are specified before treatment, in “intent-to-treat”, can answer this question. Fourth, identification of pati...

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04315948Active, not recruitingTrial of Treatments for COVID-19 in Hospitalized Adults

    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.

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  2. Version published to 10.1101/2020.09.16.20195750 on medRxiv