The clinical impact of prolonged steroid therapy in severe COVID-19 patients: a retrospective cohort study with propensity score matching
Abstract Background The optimal duration of steroid therapy for patients with COVID-19 remains unclear. This study compared clinical outcomes between early steroid withdrawal (EW; ≤10 days) and prolonged steroid tapering (PT; >10 days) in patients with severe COVID-19 requiring oxygen support. Me...
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BMC
2025-05-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-025-03674-1 |
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| author | Jaijun Han Seongman Bae Jiwon Jung Min Jae Kim Yong Pil Chong Sang-Ho Choi Sang-Oh Lee Yang Soo Kim Euijin Chang Sung-Han Kim |
| author_facet | Jaijun Han Seongman Bae Jiwon Jung Min Jae Kim Yong Pil Chong Sang-Ho Choi Sang-Oh Lee Yang Soo Kim Euijin Chang Sung-Han Kim |
| author_sort | Jaijun Han |
| collection | DOAJ |
| description | Abstract Background The optimal duration of steroid therapy for patients with COVID-19 remains unclear. This study compared clinical outcomes between early steroid withdrawal (EW; ≤10 days) and prolonged steroid tapering (PT; >10 days) in patients with severe COVID-19 requiring oxygen support. Methods This retrospective, single-center cohort study included adult patients with COVID-19 and WHO-CPS scores of 6–9 admitted to a tertiary hospital in Seoul, Republic of Korea. After 1:1 propensity score matching, 68 patients were included in each group. Primary outcomes were 28-day and 60-day mortality. Secondary outcomes included clinical aggravation, rebound pneumonia, infectious complications, readmission or emergency department (ED) revisits, duration of oxygen support, and lengths of hospitalization and ICU stay. Results Baseline characteristics were well balanced after matching. No significant differences were observed in 28-day mortality (5.9% vs. 10.3%, HR 0.54, 95% CI 0.16–1.84, p = 0.32) or 60-day mortality (14.7% vs. 11.8%, HR 1.22, 95% CI 0.48–3.10, p = 0.67) between PT and EW groups. Rates of clinical aggravation, rebound pneumonia, infectious complications, and readmission or ED revisit were also comparable. However, the PT group had significantly longer durations of oxygen support (17.5 vs. 13.0 days, p = 0.001), hospitalization (20.0 vs. 14.0 days, p = 0.001), and ICU stay (5.0 vs. 1.0 days, p = 0.01). Conclusions Prolonged steroid therapy beyond 10 days did not improve survival or other clinical outcomes in patients with severe COVID-19, suggesting that early steroid withdrawal may be appropriate for selected patients. |
| format | Article |
| id | doaj-art-8968934ff8924f3cb1d34cac780b51d1 |
| institution | Kabale University |
| issn | 1471-2466 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj-art-8968934ff8924f3cb1d34cac780b51d12025-08-20T03:53:08ZengBMCBMC Pulmonary Medicine1471-24662025-05-0125111010.1186/s12890-025-03674-1The clinical impact of prolonged steroid therapy in severe COVID-19 patients: a retrospective cohort study with propensity score matchingJaijun Han0Seongman Bae1Jiwon Jung2Min Jae Kim3Yong Pil Chong4Sang-Ho Choi5Sang-Oh Lee6Yang Soo Kim7Euijin Chang8Sung-Han Kim9Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of MedicineDepartment of Infectious Diseases, Asan Medical Center, University of Ulsan College of MedicineDepartment of Infectious Diseases, Asan Medical Center, University of Ulsan College of MedicineDepartment of Infectious Diseases, Asan Medical Center, University of Ulsan College of MedicineDepartment of Infectious Diseases, Asan Medical Center, University of Ulsan College of MedicineDepartment of Infectious Diseases, Asan Medical Center, University of Ulsan College of MedicineDepartment of Infectious Diseases, Asan Medical Center, University of Ulsan College of MedicineDepartment of Infectious Diseases, Asan Medical Center, University of Ulsan College of MedicineDepartment of Infectious Diseases, Asan Medical Center, University of Ulsan College of MedicineDepartment of Infectious Diseases, Asan Medical Center, University of Ulsan College of MedicineAbstract Background The optimal duration of steroid therapy for patients with COVID-19 remains unclear. This study compared clinical outcomes between early steroid withdrawal (EW; ≤10 days) and prolonged steroid tapering (PT; >10 days) in patients with severe COVID-19 requiring oxygen support. Methods This retrospective, single-center cohort study included adult patients with COVID-19 and WHO-CPS scores of 6–9 admitted to a tertiary hospital in Seoul, Republic of Korea. After 1:1 propensity score matching, 68 patients were included in each group. Primary outcomes were 28-day and 60-day mortality. Secondary outcomes included clinical aggravation, rebound pneumonia, infectious complications, readmission or emergency department (ED) revisits, duration of oxygen support, and lengths of hospitalization and ICU stay. Results Baseline characteristics were well balanced after matching. No significant differences were observed in 28-day mortality (5.9% vs. 10.3%, HR 0.54, 95% CI 0.16–1.84, p = 0.32) or 60-day mortality (14.7% vs. 11.8%, HR 1.22, 95% CI 0.48–3.10, p = 0.67) between PT and EW groups. Rates of clinical aggravation, rebound pneumonia, infectious complications, and readmission or ED revisit were also comparable. However, the PT group had significantly longer durations of oxygen support (17.5 vs. 13.0 days, p = 0.001), hospitalization (20.0 vs. 14.0 days, p = 0.001), and ICU stay (5.0 vs. 1.0 days, p = 0.01). Conclusions Prolonged steroid therapy beyond 10 days did not improve survival or other clinical outcomes in patients with severe COVID-19, suggesting that early steroid withdrawal may be appropriate for selected patients.https://doi.org/10.1186/s12890-025-03674-1SARS-CoV-2Severe pneumoniaSteroidMortalityRebound |
| spellingShingle | Jaijun Han Seongman Bae Jiwon Jung Min Jae Kim Yong Pil Chong Sang-Ho Choi Sang-Oh Lee Yang Soo Kim Euijin Chang Sung-Han Kim The clinical impact of prolonged steroid therapy in severe COVID-19 patients: a retrospective cohort study with propensity score matching BMC Pulmonary Medicine SARS-CoV-2 Severe pneumonia Steroid Mortality Rebound |
| title | The clinical impact of prolonged steroid therapy in severe COVID-19 patients: a retrospective cohort study with propensity score matching |
| title_full | The clinical impact of prolonged steroid therapy in severe COVID-19 patients: a retrospective cohort study with propensity score matching |
| title_fullStr | The clinical impact of prolonged steroid therapy in severe COVID-19 patients: a retrospective cohort study with propensity score matching |
| title_full_unstemmed | The clinical impact of prolonged steroid therapy in severe COVID-19 patients: a retrospective cohort study with propensity score matching |
| title_short | The clinical impact of prolonged steroid therapy in severe COVID-19 patients: a retrospective cohort study with propensity score matching |
| title_sort | clinical impact of prolonged steroid therapy in severe covid 19 patients a retrospective cohort study with propensity score matching |
| topic | SARS-CoV-2 Severe pneumonia Steroid Mortality Rebound |
| url | https://doi.org/10.1186/s12890-025-03674-1 |
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