1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study
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 i...
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| Format: | Article |
| Language: | English |
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European Respiratory Society
2024-09-01
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| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/10/5/00474-2024.full |
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| author | Olivia C. Leavy Richard J. Russell Ewen M. Harrison Nazir I. Lone Steven Kerr Annemarie B. Docherty Aziz Sheikh Matthew Richardson Omer Elneima Neil J. Greening Victoria Claire Harris Linzy Houchen-Wolloff Hamish J.C. McAuley Ruth M. Saunders Marco Sereno Aarti Shikotra Amisha Singapuri Raminder Aul Paul Beirne Charlotte E. Bolton Jeremy S. Brown Gourab Choudhury Nawar Diar Bakerly Nicholas Easom Carlos Echevarria Jonathan Fuld Nick Hart John R. Hurst Mark Jones Dhruv Parekh Paul Pfeffer Najib M. Rahman Sarah Rowland-Jones Ajay M. Shah Dan G. Wootton Caroline Jolley A.A. Roger Thompson Trudie Chalder Melanie J. Davies Anthony De Soyza John R. Geddes William Greenhalf Simon Heller Luke Howard Joseph Jacob R. Gisli Jenkins Janet M. Lord Will D-C. Man Gerry P. McCann Stefan Neubauer Peter J.M. Openshaw Joanna Porter Matthew J. Rowland Janet T. Scott Malcolm G. Semple Sally J. Singh David Thomas Mark Toshner Keir Lewis Liam G. Heaney Andrew Briggs Bang Zheng Mathew Thorpe Jennifer K. Quint James D. Chalmers Ling-Pei Ho Alex Horsley Michael Marks Krisnah Poinasamy Betty Raman Louise V. Wain Christopher E. Brightling Rachael A. Evans |
| author_facet | Olivia C. Leavy Richard J. Russell Ewen M. Harrison Nazir I. Lone Steven Kerr Annemarie B. Docherty Aziz Sheikh Matthew Richardson Omer Elneima Neil J. Greening Victoria Claire Harris Linzy Houchen-Wolloff Hamish J.C. McAuley Ruth M. Saunders Marco Sereno Aarti Shikotra Amisha Singapuri Raminder Aul Paul Beirne Charlotte E. Bolton Jeremy S. Brown Gourab Choudhury Nawar Diar Bakerly Nicholas Easom Carlos Echevarria Jonathan Fuld Nick Hart John R. Hurst Mark Jones Dhruv Parekh Paul Pfeffer Najib M. Rahman Sarah Rowland-Jones Ajay M. Shah Dan G. Wootton Caroline Jolley A.A. Roger Thompson Trudie Chalder Melanie J. Davies Anthony De Soyza John R. Geddes William Greenhalf Simon Heller Luke Howard Joseph Jacob R. Gisli Jenkins Janet M. Lord Will D-C. Man Gerry P. McCann Stefan Neubauer Peter J.M. Openshaw Joanna Porter Matthew J. Rowland Janet T. Scott Malcolm G. Semple Sally J. Singh David Thomas Mark Toshner Keir Lewis Liam G. Heaney Andrew Briggs Bang Zheng Mathew Thorpe Jennifer K. Quint James D. Chalmers Ling-Pei Ho Alex Horsley Michael Marks Krisnah Poinasamy Betty Raman Louise V. Wain Christopher E. Brightling Rachael A. Evans |
| author_sort | Olivia C. Leavy |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-1d2fc6dbfe284fe4960b0e7810b277e4 |
| institution | Kabale University |
| issn | 2312-0541 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj-art-1d2fc6dbfe284fe4960b0e7810b277e42024-11-11T16:33:07ZengEuropean Respiratory SocietyERJ Open Research2312-05412024-09-0110510.1183/23120541.00474-202400474-20241-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort studyOlivia C. Leavy0Richard J. Russell1Ewen M. Harrison2Nazir I. Lone3Steven Kerr4Annemarie B. Docherty5Aziz Sheikh6Matthew Richardson7Omer Elneima8Neil J. Greening9Victoria Claire Harris10Linzy Houchen-Wolloff11Hamish J.C. McAuley12Ruth M. Saunders13Marco Sereno14Aarti Shikotra15Amisha Singapuri16Raminder Aul17Paul Beirne18Charlotte E. Bolton19Jeremy S. Brown20Gourab Choudhury21Nawar Diar Bakerly22Nicholas Easom23Carlos Echevarria24Jonathan Fuld25Nick Hart26John R. Hurst27Mark Jones28Dhruv Parekh29Paul Pfeffer30Najib M. Rahman31Sarah Rowland-Jones32Ajay M. Shah33Dan G. Wootton34Caroline Jolley35A.A. Roger Thompson36Trudie Chalder37Melanie J. Davies38Anthony De Soyza39John R. Geddes40William Greenhalf41Simon Heller42Luke Howard43Joseph Jacob44R. Gisli Jenkins45Janet M. Lord46Will D-C. Man47Gerry P. McCann48Stefan Neubauer49Peter J.M. Openshaw50Joanna Porter51Matthew J. Rowland52Janet T. Scott53Malcolm G. Semple54Sally J. Singh55David Thomas56Mark Toshner57Keir Lewis58Liam G. Heaney59Andrew Briggs60Bang Zheng61Mathew Thorpe62Jennifer K. Quint63James D. Chalmers64Ling-Pei Ho65Alex Horsley66Michael Marks67Krisnah Poinasamy68Betty Raman69Louise V. Wain70Christopher E. Brightling71Rachael A. Evans72 Department of Population Health Sciences, University of Leicester, Leicester, UK The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK The Usher Institute, University of Edinburgh, Edinburgh, UK Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK The Usher Institute, University of Edinburgh, Edinburgh, UK The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University of Leicester, Leicester, UK The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK St George's University Hospitals NHS Foundation Trust, London, UK The Leeds Teaching Hospitals NHS Trust, Leeds, UK University of Nottingham, Nottingham, UK UCL Respiratory, Department of Medicine, University College London, Rayne Institute, London, UK University of Edinburgh, Edinburgh, UK Manchester Metropolitan University, Manchester, UK Infection Research Group, Hull University Teaching Hospitals, Hull, UK The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK Department of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK Lane Fox Respiratory Service, Guy's and St Thomas NHS Foundation Trust, London, UK University College London, London, UK Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK University of Birmingham, Birmingham, UK Barts Health NHS Trust, London, UK Oxford University Hospitals NHS Foundation Trust, Oxford, UK University of Sheffield, Sheffield, UK Kings College London, London, UK Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK Kings College London, London, UK University of Sheffield, Sheffield, UK Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK University Hospitals of Leicester NHS Trust, Leicester, UK Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK Imperial College Healthcare NHS Trust, London, UK Centre for Medical Image Computing, University College London, London, UK National Heart and Lung Institute, Imperial College London, London, UK MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK Royal Brompton and Harefield Clinical Group, Guy's and St Thomas NHS Foundation Trust, London, UK NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK National Heart and Lung Institute, Imperial College London, London, UK UCL Respiratory, Department of Medicine, University College London, Rayne Institute, London, UK Kadoorie Centre for Critical Care Research, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK MRC–University of Glasgow Centre for Virus Research, Glasgow, UK NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK Imperial College London, London, UK NIHR Cambridge Clinical Research Facility, Cambridge, UK Hywel Dda University Health Board, Wales, UK Wellcome–Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK London School of Hygiene and Tropical Medicine, London, UK London School of Hygiene and Tropical Medicine, London, UK Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK NHLI, Imperial College London, London, UK University of Dundee, Ninewells Hospital and Medical School, Dundee, UK NIHR Oxford Biomedical Research Centre, Oxford, UK Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK Asthma and Lung UK, London, UK Oxford University Hospitals NHS Foundation Trust, Oxford, UK Department of Population Health Sciences, University of Leicester, Leicester, UK The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK 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.http://openres.ersjournals.com/content/10/5/00474-2024.full |
| spellingShingle | Olivia C. Leavy Richard J. Russell Ewen M. Harrison Nazir I. Lone Steven Kerr Annemarie B. Docherty Aziz Sheikh Matthew Richardson Omer Elneima Neil J. Greening Victoria Claire Harris Linzy Houchen-Wolloff Hamish J.C. McAuley Ruth M. Saunders Marco Sereno Aarti Shikotra Amisha Singapuri Raminder Aul Paul Beirne Charlotte E. Bolton Jeremy S. Brown Gourab Choudhury Nawar Diar Bakerly Nicholas Easom Carlos Echevarria Jonathan Fuld Nick Hart John R. Hurst Mark Jones Dhruv Parekh Paul Pfeffer Najib M. Rahman Sarah Rowland-Jones Ajay M. Shah Dan G. Wootton Caroline Jolley A.A. Roger Thompson Trudie Chalder Melanie J. Davies Anthony De Soyza John R. Geddes William Greenhalf Simon Heller Luke Howard Joseph Jacob R. Gisli Jenkins Janet M. Lord Will D-C. Man Gerry P. McCann Stefan Neubauer Peter J.M. Openshaw Joanna Porter Matthew J. Rowland Janet T. Scott Malcolm G. Semple Sally J. Singh David Thomas Mark Toshner Keir Lewis Liam G. Heaney Andrew Briggs Bang Zheng Mathew Thorpe Jennifer K. Quint James D. Chalmers Ling-Pei Ho Alex Horsley Michael Marks Krisnah Poinasamy Betty Raman Louise V. Wain Christopher E. Brightling Rachael A. Evans 1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study ERJ Open Research |
| title | 1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study |
| title_full | 1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study |
| title_fullStr | 1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study |
| title_full_unstemmed | 1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study |
| title_short | 1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study |
| title_sort | 1 year health outcomes associated with systemic corticosteroids for covid 19 a longitudinal cohort study |
| url | http://openres.ersjournals.com/content/10/5/00474-2024.full |
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