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1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study

Olivia C. Leavy, Richard Russell, Ewen M. Harrison, Nazir Lone, Steven Kerr, Annemarie B Docherty, Aziz Sheikh, Matthew Richardson, Omer Elneima, Neil Greening, Victoria Harris, Linzy Houchen-Wolloff, Hamish McAuley, Ruth Saunders, Marco Sereno, Aarti Shikotra, Amisha Singapuri, Raminder Aul, Paul Beirne, Charlotte E. Bolton, Jeremy Brown, Gourab Choudhury, Nawar Diar Bakerly, Nicholas Easom, Carlos Echevarria, Jonathan Fuld, Nicholas Hart, John R. Hurst, Mark G. Jones, Dhruv Parekh, Paul Pfeffer, Najib M. Rahman, Sarah Rowland‐Jones, Ajay M. Shah, Dan Wootton, Caroline J. Jolley, A. A. Roger Thompson, Trudie Chalder, Melanie J. Davies, Anthony De Soyza, John R. Geddes, William Greenhalf, Simon Heller, Luke Howard, Joseph Jacob, Gísli Jenkins, Janet M. Lord, William D‐C Man, Gerry P McCann, Stefan Neubauer, Peter Openshaw, Joanna C. Porter, Matthew Rowland, J. T. Scott, Malcolm G. Semple, Sally 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

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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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Long-Term Effects of COVID-19COVID-19 Clinical Research StudiesAdrenal Hormones and Disorders

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