The Outcome of High-Dose Corticosteroid Treatment Among Coronavirus Disease 2019 Patients

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Abstract
This study aimed to demonstrate the association between high-dose corticosteroid administration and adverse outcomes in coronavirus disease 2019 patients. Data were collected retrospectively from medical records. The primary outcome was invasive mechanical ventilation or death, whichever occurred first. The secondary outcome was all-cause in-hospital mortality. The standard dose was defined as a daily dose of ≤1.5 mg/kg of prednisolone or equivalent, and the high-dose was defined as ≥250 mg of prednisolone or equivalent. Data were analyzed using frequentist and Bayesian logistic models. In addition, a propensity score–matched subgroup was analyzed for the association between high-dose corticosteroid use and adverse outcomes. A total of 1072 patients hospitalized between September 29, 2020, and April 20, 2021, were enrolled in the study. Of these, 188 patients (18%) had a primary outcome; 55 patients (29%) died, and 133 (71%) required invasive mechanical ventilation. Higher age was associated with adverse outcomes in all analyses. Standard dose corticosteroid use was found to be protective (odds ratio [95% confidence interval], 0.53 [0.35–0.81]) in the final logistic model. Point estimates in the propensity score–matched subgroup did not encourage high-dose corticosteroid use (odds ratio [95% confidence interval], 3.06 [0.98–9.50]). The posterior probability density distributions generated by the Bayesian logistic model implicated standard-dose corticosteroid use as protective (80% credible intervals, −0.839 to −0.313), whereas it implicated high-dose corticosteroid use as associated with adverse outcomes (80% credible intervals, 0.163–0.941). This study found high-dose corticosteroid (≥250 mg prednisolone daily) use associated with adverse outcomes.

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