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

  1. Gallay Laure
  2. Tran Viet-Thi
  3. Perrodeau Elodie
  4. Vignier Nicolas
  5. Mahevas Matthieu
  6. Bisio Francesca
  7. Forestier Emmanuel
  8. Lescure Francois-Xavier

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Abstract

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

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  1. ScreenIT

    SciScore for 10.1101/2020.11.10.20226886: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationTo account for immortal time bias, all patients in the control group who died during the grace period were randomly assigned to one of the two groups, given that their observational data were compatible with both groups at the time of the event 7.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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:
    The present study suffered several limitations. Despite the use of robust methods and statistical techniques to draw causal inferences, the study remains observational and potential unmeasured confounders may bias the results 10. Also, the prescriptions of corticosteroids were heterogeneous in terms of drugs, time of start, dose, and duration. Finally, the follow-up was limited at 14 days. Yet, deaths occurred mainly before day 10, and patients particularly frail were managed frequently in a rescue context without practicing intensive care. Altogether, our results support the WHO guidelines, and expand them to patients over 80 years old without contra-indication. They send a good signal for elderly, including those living in long terms care facilities or other institutions where corticosteroids could be prescribed according to an oxygen criterion, without systematic transfer to the hospital. Strengthening the therapeutic arsenal for the care of elderly with COVID-19 is critical as these patients may not fully benefit from vaccination because of the immune-senescence associated with advanced age and their exclusion from vaccine trials 4.

    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

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  2. Version published to 10.1101/2020.11.10.20226886v1 on medRxiv