1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study

Abstract

Background In patients with coronavirus disease 2019 (COVID-19) requiring supplemental oxygen, dexamethasone reduces acute severity and improves survival, but longer-term effects are unknown. We hypothesised that systemic corticosteroid administration during acute COVID-19 would be associated with improved health-related quality of life (HRQoL) 1 year after discharge.

Methods Adults admitted to hospital between February 2020 and March 2021 for COVID-19 and meeting current guideline recommendations for dexamethasone treatment were included using two prospective UK cohort studies (Post-hospitalisation COVID-19 and the International Severe Acute Respiratory and emerging Infection Consortium). HRQoL, assessed by the EuroQol-Five Dimensions–Five Levels utility index (EQ-5D-5L UI), pre-hospital and 1 year after discharge were compared between those receiving corticosteroids or not after propensity weighting for treatment. Secondary outcomes included patient-reported recovery, physical and mental health status, and measures of organ impairment. Sensitivity analyses were undertaken to account for survival and selection bias.

Findings Of the 1888 participants included in the primary analysis, 1149 received corticosteroids. There was no between-group difference in EQ-5D-5L UI at 1 year (mean difference 0.004, 95% CI −0.026–0.034). A similar reduction in EQ-5D-5L UI was seen at 1 year between corticosteroid exposed and nonexposed groups (mean±sd change −0.12±0.22 versus −0.11±0.22). Overall, there were no differences in secondary outcome measures. After sensitivity analyses modelled using a cohort of 109 318 patients admitted to hospital with COVID-19, EQ-5D-5L UI at 1 year remained similar between the two groups.

Interpretation Systemic corticosteroids for acute COVID-19 have no impact on the large reduction in HRQoL 1 year after hospital discharge. Treatments to address the persistent reduction in HRQoL are urgently needed.

Metadata

Item Type:	Article
Authors/Creators:	Leavy, O.C. Russell, R.J. https://orcid.org/0000-0002-0195-0812 Harrison, E.M. Lone, N.I. https://orcid.org/0000-0003-2707-2779 Kerr, S. Docherty, A.B. Sheikh, A. Richardson, M. Elneima, O. https://orcid.org/0000-0003-2480-8840 Greening, N.J. https://orcid.org/0000-0003-0453-7529 Harris, V.C. Houchen-Wolloff, L. McAuley, H.J.C. https://orcid.org/0000-0001-8997-0764 Saunders, R.M. Sereno, M. Shikotra, A. Singapuri, A. Aul, R. Beirne, P. Bolton, C.E. https://orcid.org/0000-0002-9578-2249 Brown, J.S. Choudhury, G. Diar Bakerly, N. Easom, N. Echevarria, C. Fuld, J. Hart, N. https://orcid.org/0000-0002-6863-585X Hurst, J.R. https://orcid.org/0000-0002-7246-6040 Jones, M. https://orcid.org/0000-0001-6308-6014 Parekh, D. https://orcid.org/0000-0002-1508-8362 Pfeffer, P. Rahman, N.M. Rowland-Jones, S. Shah, A.M. Wootton, D.G. Jolley, C. https://orcid.org/0000-0003-3538-2451 Thompson, A.A.R. https://orcid.org/0000-0002-0717-4551 Chalder, T. Davies, M.J. De Soyza, A. https://orcid.org/0000-0002-8566-0344 Geddes, J.R. Greenhalf, W. Heller, S. Howard, L. https://orcid.org/0000-0003-2822-210X Jacob, J. https://orcid.org/0000-0002-8054-2293 Jenkins, R.G. Lord, J.M. Man, W.D.-C. https://orcid.org/0000-0002-3782-659X McCann, G.P. Neubauer, S. Openshaw, P.J.M. https://orcid.org/0000-0002-7220-2555 Porter, J. https://orcid.org/0000-0002-7307-169X Rowland, M.J. Scott, J.T. Semple, M.G. https://orcid.org/0000-0001-9700-0418 Singh, S.J. https://orcid.org/0000-0002-9834-0366 Thomas, D. Toshner, M. https://orcid.org/0000-0002-3969-6143 Lewis, K. Heaney, L.G. Briggs, A. Zheng, B. Thorpe, M. Quint, J.K. https://orcid.org/0000-0003-0149-4869 Chalmers, J.D. Ho, L.-P. Horsley, A. https://orcid.org/0000-0003-1828-0058 Marks, M. https://orcid.org/0000-0002-7585-4743 Poinasamy, K. Raman, B. https://orcid.org/0000-0002-1239-9608 Wain, L.V. https://orcid.org/0000-0003-4951-1867 Brightling, C.E. Evans, R.A. https://orcid.org/0000-0002-1667-868X
Copyright, Publisher and Additional Information:	© 2024 The Authors. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Dates:	Published: 30 September 2024 Published (online): 30 September 2024 Accepted: 15 May 2024
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health
Depositing User:	Symplectic Sheffield
Date Deposited:	14 Oct 2024 09:58
Last Modified:	14 Oct 2024 09:58
Published Version:	http://dx.doi.org/10.1183/23120541.00474-2024
Status:	Published
Publisher:	European Respiratory Society (ERS)
Refereed:	Yes
Identification Number:	10.1183/23120541.00474-2024
Related URLs:	PubMed URL
Sustainable Development Goals:
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:218258

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1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study

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