Steroids may reduce risk for death after severe COVID-19 hospitalization


Disclosures: The authors report no relevant financial information.

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According to data published in Frontiers in medicine.

“Patients who have recovered from COVID-19 are at increased risk of hospitalization and death within 6-12 months of the initial episode,” Arch G. Mainous III, PhD, from the University of Florida, and his colleagues wrote. “This morbidity and mortality is generally not listed or considered as COVID-19-related hospitalization or death in medical records and is therefore underreported as post-acute sequelae of COVID-19. The reason for this phenomenon of severe consequences as post-acute sequelae of COVID-19 is not well understood.

Chart breaking down study details with a cartoon pill bottle on the left.
Anti-inflammatory drugs like steroids at hospital discharge may reduce the risk of post-acute infection mortality in patients who experienced hyperinflammation due to severe COVID-19, according to data derived from Mainous A, et al. Middle front. 2022;doi:10.3389/fmed.2022.891375.

“Furthermore, even 40-60 days after acute COVID-19 infection, there is evidence of a significant remaining inflammatory response in patients,” they added. “…Following this hyperinflammation, the use of steroids as anti-inflammatory treatments in patients with high inflammation during the initial episode of COVID-19 may do more than just help in the initial episode, but may act as a buffer for downstream morbidity and mortality from the initial episode of COVID-19.

To examine the relationship between systemic inflammation in hospitalized adults with COVID-19 and post-recovery mortality, Mainous and colleagues analyzed a longitudinal cohort of patients within a large healthcare system. Patients included in the analysis were 18 years of age or older and were tested for COVID-19 between January 1, 2020 and December 31, 2021 in the University of Florida Health System. Patients were only included if they were hospitalized with COVID-19.

Patients were considered hospitalized if admitted within 30 days of a positive COVID-19 test. In addition, patients were only included in the final analysis if they had maintained at least 365 days of follow-up.

C-reactive protein (CRP) was the unit used to measure inflammation, and patients were included only if they had been tested for CRP “during their first episode of COVID-19 care”, wrote the researchers. If multiple tests were performed, the highest value was used for analysis. Mainous and colleagues also assessed intravenous dexamethasone given during hospitalization, as well as prescriptions for oral dexamethasone that were prescribed in hospital or after discharge.

The primary outcome was 365-day all-cause mortality, derived from electronic health records and Social Security Death Index. However, patients were censored by date of death and causes of death were not reliably reported, the researchers wrote.

According to the researchers, higher than normal CRP was associated with other markers of severe COVID-19, including the use of supplemental oxygen and intravenous dexamethasone.

Additionally, increased CRP was correlated with an increased risk of mortality after recovery from acute COVID-19, with an unadjusted relative risk of 1.6 (95% CI, 1.18-2.17 ) and an adjusted hazard ratio of 1.61 (95% CI, 1.19-2.2). Meanwhile, prescribing oral steroids at hospital discharge was associated with a lower risk of death (HR=0.49; 95% CI, 0.73-0.94).

“Hyperinflammation present with severe COVID-19 is associated with an increased risk of mortality after hospital discharge,” Mainous and colleagues wrote. “Although suggestive, treatment with anti-inflammatory drugs like steroids at hospital discharge is associated with a decreased risk of post-acute mortality from COVID-19.

“This suggests that treating inflammation may also benefit other post-acute sequelae such as long COVID,” they added. “A reconceptualization of COVID-19 as an acute and chronic disease may be helpful.”

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