Margaux Lafaurie1,2, Guillaume Martin-Blondel3,4, Pierre Delobel3,4, Nassim Kamar5,6, Sandrine Charpentier7, Agnès Sommet8,9, Guillaume Moulis9,10. 1. Service de Pharmacologie Médicale, Centre Hospitalier Universitaire de Toulouse, Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France. margaux.lafaurie@univ-tlse3.fr. 2. Centre d'investigation clinique 1436, axe pharmacoépidémiologie, Centre Hospitalier Universitaire de Toulouse-Purpan, place du Dr Baylac, TSA40031, 31059, Toulouse, Cedex 9, France. margaux.lafaurie@univ-tlse3.fr. 3. Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Toulouse-Purpan, place du Dr Baylac, TSA40031, 31059, Toulouse, Cedex 9, France. 4. UMR INSERM/CNRS 1043, Centre de Physiopathologie Toulouse Purpan, 330 avenue de Grande-Bretagne, 31059, Toulouse, Cedex 9, France. 5. Service de Néphrologie et Transplantation d'Organes, Centre Hospitalier Universitaire de Toulouse-Rangueil, 1, avenue du Professeur Jean Poulhès - TSA 50032, 31059, Toulouse cedex 9, France. 6. INSERM U1043, IFR -BMT, Université Paul Sabatier, Toulouse, France. 7. Service des Urgences, Centre Hospitalier Universitaire de Toulouse, Toulouse, France. 8. Service de Pharmacologie Médicale, Centre Hospitalier Universitaire de Toulouse, Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France. 9. Centre d'investigation clinique 1436, axe pharmacoépidémiologie, Centre Hospitalier Universitaire de Toulouse-Purpan, place du Dr Baylac, TSA40031, 31059, Toulouse, Cedex 9, France. 10. Service de Médecine Interne, salle Le Tallec, Centre Hospitalier Universitaire de Toulouse-Purpan, place du Dr Baylac, TSA40031, 31059, Toulouse, Cedex 9, France.
Abstract
BACKGROUND: The impact of prior exposure to systemic corticosteroids on COVID-19 severity in patients hospitalized for a SARS-CoV-2 pneumonia is not known. The present study was designed to answer to this question. METHODS: The population study was the Covid-Clinic-Toul cohort which records data about all hospitalized patients with a positive reverse transcriptase polymerase chain reaction for a SARS-CoV-2 infection at Toulouse University hospital, France. Exposure to systemic corticosteroids was assessed at hospital admission. A propensity score (PS) according to corticosteroid exposure was calculated including comorbidities, clinical, radiological and biological variables that impact COVID-19 severity. The primary outcome was composite, including admission to intensive care unit, need of mechanical ventilation and death occurring during the 14 days after hospital admission. Logistic regression models adjusted for the PS (overlap weighting) provided odds ratios (ORs) and their 95% confidence intervals (95% CIs). RESULTS: Overall, 253 patients were included in the study. Median age was 64 years, 140 patients (59.6%) were men and 218 (86.2%) had at least one comorbidity. Seventeen patients (6.7%) were exposed to corticosteroids before hospital admission. Chronic inflammatory disease (n = 8) was the most frequent indication. One hundred and twenty patients (47.4%) met the composite outcome. In the crude model, the OR of previous exposure to systemic corticosteroids was 1.64; 95% CI: 0.60-4.44. In the adjusted model, it was 1.09 (95% CI: 0.65-1.83). CONCLUSION: Overall, this study provide some evidences for an absence of an increased risk of unfavorable outcome with previous exposure to corticosteroids in the general setting of patients hospitalized for COVID-19.
BACKGROUND: The impact of prior exposure to systemic corticosteroids on COVID-19 severity in patients hospitalized for a SARS-CoV-2 pneumonia is not known. The present study was designed to answer to this question. METHODS: The population study was the Covid-Clinic-Toul cohort which records data about all hospitalized patients with a positive reverse transcriptase polymerase chain reaction for a SARS-CoV-2 infection at Toulouse University hospital, France. Exposure to systemic corticosteroids was assessed at hospital admission. A propensity score (PS) according to corticosteroid exposure was calculated including comorbidities, clinical, radiological and biological variables that impact COVID-19 severity. The primary outcome was composite, including admission to intensive care unit, need of mechanical ventilation and death occurring during the 14 days after hospital admission. Logistic regression models adjusted for the PS (overlap weighting) provided odds ratios (ORs) and their 95% confidence intervals (95% CIs). RESULTS: Overall, 253 patients were included in the study. Median age was 64 years, 140 patients (59.6%) were men and 218 (86.2%) had at least one comorbidity. Seventeen patients (6.7%) were exposed to corticosteroids before hospital admission. Chronic inflammatory disease (n = 8) was the most frequent indication. One hundred and twenty patients (47.4%) met the composite outcome. In the crude model, the OR of previous exposure to systemic corticosteroids was 1.64; 95% CI: 0.60-4.44. In the adjusted model, it was 1.09 (95% CI: 0.65-1.83). CONCLUSION: Overall, this study provide some evidences for an absence of an increased risk of unfavorable outcome with previous exposure to corticosteroids in the general setting of patients hospitalized for COVID-19.
Entities:
Keywords:
COVID-19; Intensive care unit; Mortality; Pharmacoepidemiology; SARS-COV-2; Systemic corticosteroids
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