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.

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Cite as

Leavy, O., Russell, R., Harrison, E., Lone, N., Kerr, S., Docherty, A., Sheikh, A., Richardson, M., Elneima, O., Greening, N., Harris, V., Houchen-Wolloff, L., McAuley, H., Saunders, R., Sereno, M., Shikotra, A., Singapuri, A., Aul, R., Beirne, P., Bolton, C., Brown, J., Choudhury, G., Diar Bakerly, N., Easom, N., Echevarria, C., Fuld, J., Hart, N., Hurst, J., Jones, M., Parekh, D., Pfeffer, P., Rahman, N., Rowland-Jones, S., Shah, A., Wootton, D., Jolley, C., Thompson, A., Chalder, T., Davies, M., De Soyza, A., Geddes, J., Greenhalf, W., Heller, S., Howard, L., Jacob, J., Jenkins, R., Lord, J., Man, W., McCann, G., Neubauer, S., Openshaw, P., Porter, J., Rowland, M., Scott, J., Semple, M., Singh, S., Thomas, D., Toshner, M., Lewis, K., Heaney, L., Briggs, A., Zheng, B., Thorpe, M., Quint, J., Chalmers, J., Ho, L., Horsley, A., Marks, M., Poinasamy, K., Raman, B., Wain, L., Brightling, C. & Evans, R. 2024, '1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study', ERJ Open Research. https://doi.org/10.1183/23120541.00474-2024

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Last updated: 19 November 2024
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