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      Corticosteroid Therapy in COVID-19 Associated With In-hospital Mortality in Geriatric Patients: A Propensity Matched Cohort Study

      research-article
      Author(s): , MD, , MD, , MD, , MD, , MD, , MD, , MD, , MD, , MD, , MD, , MD, , MD, , MD, PhD, , MD, PhD, , MD, PhD, , MD, , MD, , MD, , MD, PhD, , MD, PhD, , MD, , MD, PhD, , MD, PhD, , MD, PhD
      Editor(s): , MD, FGSA
      Publication date (Electronic):
      Journal: The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
      Publisher: Oxford University Press
      Keywords: Older patients, SARS-CoV-2, Treatment

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          Abstract

          Background

          Few data are available on the prognosis of older patients who received corticosteroids for COVID-19. We aimed to compare the in-hospital mortality of geriatric patients hospitalized for COVID-19 who received corticosteroids or not.

          Methods

          We conducted a multicentric retrospective cohort study in 15 acute COVID-19 geriatric wards in the Paris area from March to April 2020 and November 2020 to May 2021. We included all consecutive patients aged 70 years and older who were hospitalized with confirmed COVID-19 in these wards. Propensity score and multivariate analyses were used.

          Results

          Of the 1 579 patients included (535 received corticosteroids), the median age was 86 (interquartile range 81–91) years, 56% of patients were female, the median Charlson Comorbidity Index (CCI) was 2.6 (interquartile range 1–4), and 64% of patients were frail (Clinical Frailty Score 5–9). The propensity score analysis paired 984 patients (492 with and without corticosteroids). The in-hospital mortality was 32.3% in the matched cohort. On multivariate analysis, the probability of in-hospital mortality was increased with corticosteroid use (odds ratio [OR] = 2.61 [95% confidence interval (CI) 1.63–4.20]). Other factors associated with in-hospital mortality were age (OR = 1.04 [1.01–1.07], CCI (OR = 1.18 [1.07–1.29], activities of daily living (OR = 0.85 [0.75–0.95], oxygen saturation < 90% on room air (OR = 2.15 [1.45–3.17], C-reactive protein level (OR = 2.06 [1.69–2.51], and lowest lymphocyte count (OR = 0.49 [0.38–0.63]). Among the 535 patients who received corticosteroids, 68.3% had at least one corticosteroid side effect, including delirium (32.9%), secondary infections (32.7%), and decompensated diabetes (14.4%).

          Conclusions

          In this multicentric matched-cohort study of geriatric patients hospitalized for COVID-19, the use of corticosteroids was significantly associated with in-hospital mortality.

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          Most cited references39

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          Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

          Mark Peters (2021)
          Abstract Background Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. Methods In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the preliminary results of this comparison. Results A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55). Conclusions In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936; ISRCTN number, 50189673.)
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            Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

            Safiya Richardson, Jamie Hirsch, Mangala Narasimhan … (2020)
            There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19).
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              Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review

              W. Joost Wiersinga, Andrew Rhodes, Allen Cheng … (2020)
              The coronavirus disease 2019 (COVID-19) pandemic, due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a worldwide sudden and substantial increase in hospitalizations for pneumonia with multiorgan disease. This review discusses current evidence regarding the pathophysiology, transmission, diagnosis, and management of COVID-19.
              Article 0 comments Cited 2392 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Valentine Lidou-Renault
                Edouard Baudouin
                Pauline Courtois-Amiot
                Celine Bianco
                Hélène Esnault
                Audrey Rouet
                Margaux Baque
                Charlotte Tomeo
                Antonio Rainone
                Sara Thietart
                Romain Veber
                Clementine Ayache
                Marion Pepin:
                ORCID: https://orcid.org/0000-0002-3064-2480
                Carmelo Lafuente-Lafuente
                Emmanuelle Duron:
                ORCID: https://orcid.org/0000-0001-6680-3613
                Pierre-Emmanuel Cailleaux:
                ORCID: https://orcid.org/0000-0001-7814-7481
                Didier Haguenauer
                Nadège Lemarié
                Elena Paillaud
                Agathe Raynaud-Simon
                Caroline Thomas
                Jacques Boddaert
                Lorène Zerah
                Hélène Vallet:
                ORCID: https://orcid.org/0000-0002-3593-5055
                Lewis A Lipsitz: Role: Decision Editor
                Journal
                Journal ID (nlm-ta): J Gerontol A Biol Sci Med Sci
                Journal ID (iso-abbrev): J Gerontol A Biol Sci Med Sci
                Journal ID (publisher-id): gerona
                Title: The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
                Publisher: Oxford University Press (US )
                ISSN (Print): 1079-5006
                ISSN (Electronic): 1758-535X
                Publication date (Electronic): 08 April 2022
                Publication date PMC-release: 08 April 2022
                Electronic Location Identifier: glac084
                Affiliations
                Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Saint Antoine, Department of Geriatric Medicine , Paris, France
                Assistance Publique-Hôpitaux de Paris (APHP), University hospital of Paris-Saclay, Department of Geriatric Medicine, Paul Brousse Hospital , Villejuif, France
                Université Paris-Saclay, INSERM 1178, CESP, Équipe MOODS , Le Kremlin-Bicêtre, France
                Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, Hôpital Bichat, Department of Geriatric Medicine , Paris, France
                Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Saint Antoine, Department of Geriatric Medicine , Paris, France
                Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, Hôpital Bichat, Department of Geriatric Medicine , Paris, France
                Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Tenon, Department of Geriatric Medicine , Paris, France
                Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Saint Antoine, Department of Geriatric Medicine , Paris, France
                Sorbonne Université, INSERM UMR1135, Centre d’immunologie et des Maladies Infectieuses , Paris, France
                Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Rothschild, Department of Geriatric Medicine , Paris, France
                Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Charles Foix, Department of Geriatric Medicine , Ivry Sur Seine, France
                Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Pitié Salpêtrière, Department of Geriatric Medicine , Paris, France
                Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Rothschild, Department of Geriatric Medicine , Paris, France
                Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Rothschild, Department of Geriatric Medicine , Paris, France
                Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Ambroise Paré, Department of Geriatric Medicine , Boulogne, Billancourt,  France
                Université de Versailles Saint-Quentin en Yvelines, Université Paris-Saclay, INSERM, CESP, Clinical Epidemiology , Villejuif, France
                Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Charles Foix, Department of Geriatric Medicine , Ivry Sur Seine, France
                Assistance Publique-Hôpitaux de Paris (APHP), University hospital of Paris-Saclay, Department of Geriatric Medicine, Paul Brousse Hospital , Villejuif, France
                Université Paris-Saclay, INSERM 1178, CESP, Équipe MOODS , Le Kremlin-Bicêtre, France
                Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Department of Geriatric Medicine , Colombes, France
                Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Department of Geriatric Medicine , Colombes, France
                Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Tenon, Department of Geriatric Medicine , Paris, France
                Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, Paris Cancer Institute CARPEM, Department of Geriatric Medicine, Hôpital Européen Georges Pompidou , Paris, France
                Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, Hôpital Bichat, Department of Geriatric Medicine , Paris, France
                Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Saint Antoine, Department of Geriatric Medicine , Paris, France
                Sorbonne Université, INSERM UMR1135, Centre d’immunologie et des Maladies Infectieuses , Paris, France
                Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Pitié Salpêtrière, Department of Geriatric Medicine , Paris, France
                Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Pitié Salpêtrière, Department of Geriatric Medicine , Paris, France
                Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, IPLESP , Paris, France
                Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Saint Antoine, Department of Geriatric Medicine , Paris, France
                Sorbonne Université, INSERM UMR1135, Centre d’immunologie et des Maladies Infectieuses , Paris, France
                Author notes
                Address correspondence to: Hélène Vallet, MD, PhD, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Saint Antoine, Department of Geriatric Medicine, 184 rue du Faubourg Saint Antoine, Paris 75012, France. E-mail: Helene.vallet@ 123456aphp.fr

                These authors contributed equally to this study.

                Author information
                https://orcid.org/0000-0002-3064-2480
                https://orcid.org/0000-0001-6680-3613
                https://orcid.org/0000-0001-7814-7481
                https://orcid.org/0000-0002-3593-5055
                Article
                Publisher ID: glac084
                DOI: 10.1093/gerona/glac084
                PMC ID: 9129112
                PubMed ID: 35395678
                SO-VID: 4aec45b8-a5c7-438d-955c-655c525dae5f
                Copyright © © The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
                License:

                This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Date received : 10 January 2022
                Date: 30 March 2022
                Date: 17 May 2022
                Page count
                Pages: 9
                Categories
                Subject: Research Article
                Subject: AcademicSubjects/MED00280
                Subject: AcademicSubjects/SCI00960
                Custom metadata
                article-lifecycle PAP
                edited-state corrected-proof

                ScienceOpen disciplines: Geriatric medicine
                Keywords: older patients,sars-cov-2,treatment
                Data availability:
                ScienceOpen disciplines: Geriatric medicine
                Keywords: older patients, sars-cov-2, treatment

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