Impact of chronic oral glucocorticoid treatment on mortality in patients with COVID-19: analysis of a population-based cohort.
BMJ Open
; 14(3): e080640, 2024 Mar 15.
Article
in En
| MEDLINE
| ID: mdl-38490654
ABSTRACT
OBJECTIVES:
While glucocorticoid (GC) treatment initiated for COVID-19 reduces mortality, it is unclear whether GC treatment prior to COVID-19 affects mortality. Long-term GC use raises infection and thromboembolic risks. We investigated if patients with oral GC use prior to COVID-19 had increased mortality overall and by selected causes.DESIGN:
Population-based observational cohort study. SETTINGS Population-based register data in Sweden.PARTICIPANTS:
All patients infected with COVID-19 in Sweden from January 2020 to November 2021 (n=1 200 153). OUTCOMEMEASURES:
Any prior oral GC use was defined as ≥1 GC prescription during 12 months before index. High exposure was defined as ≥2 GC prescriptions with a cumulative prednisolone dose ≥750 mg or equivalent during 6 months before index. GC users were compared with COVID-19 patients who had not received GCs within 12 months before index. We used Cox proportional hazard models and 12 propensity score matching to estimate HRs and 95% CIs, controlling for the same confounders in all analyses.RESULTS:
3378 deaths occurred in subjects with any prior GC exposure (n=48 806; 6.9%) and 14 850 among non-exposed (n=1 151 347; 1.3%). Both high (HR 1.98, 95% CI 1.87 to 2.09) and any exposure (1.58, 1.52 to 1.65) to GCs were associated with overall death. Deaths from pulmonary embolism, sepsis and COVID-19 were associated with high GC exposure and, similarly but weaker, with any exposure. High exposure to GCs was associated with increased deaths caused by stroke and myocardial infarction.CONCLUSION:
Patients on oral GC treatment prior to COVID-19 have increased mortality, particularly from pulmonary embolism, sepsis and COVID-19.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pulmonary Embolism
/
Sepsis
/
COVID-19
Limits:
Humans
Language:
En
Journal:
BMJ Open
Year:
2024
Document type:
Article
Affiliation country:
Sweden
Country of publication:
United kingdom