• Jianfeng Wu, Jianqiang Huang, Guochao Zhu, Yihao Liu, Han Xiao, Qian Zhou, Xiang Si, Hui Yi, Cuiping Wang, Daya Yang, Shuling Chen, Xin Liu, Zelong Liu, Qiongya Wang, Qingquan Lv, Ying Huang, Yang Yu, Xiangdong Guan, Yanbing Li, Krishnarajah Nirantharakumar, KarKeung Cheng, Sui Peng, and Haipeng Xiao.
• Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
• J. Clin. Endocrinol. Metab. 2020 Dec 1; 105 (12).

BackgroundSystemic corticosteroids are now recommended in many treatment guidelines, although supporting evidence is limited to 1 randomized controlled clinical trial (RECOVERY).ObjectiveTo identify whether corticosteroids were beneficial to COVID-19 patients.MethodsA total of 1514 severe and 249 critical hospitalized COVID-19 patients from 2 medical centers in Wuhan, China. Multivariable Cox models, Cox model with time-varying exposure and propensity score analysis (inverse-probability-of-treatment-weighting [IPTW] and propensity score matching [PSM]) were used to estimate the association of corticosteroid use with risk of in-hospital mortality in severe and critical cases.ResultsCorticosteroids were administered in 531 (35.1%) severe and 159 (63.9%) critical patients. Compared to the non-corticosteroid group, systemic corticosteroid use was not associated with beneficial effect in reducing in-hospital mortality in either severe cases (HR = 1.77; 95% CI, 1.08-2.89; P = 0.023), or critical cases (HR = 2.07; 95% CI, 1.08-3.98; P = 0.028). Findings were similar in time-varying Cox analysis. For patients with severe COVID-19 at admission, corticosteroid use was not associated with improved or harmful outcome in either PSM or IPTW analysis. For critical COVID-19 patients at admission, results were consistent with multivariable Cox model analysis.ConclusionCorticosteroid use was not associated with beneficial effect in reducing in-hospital mortality for severe or critical cases in Wuhan. Absence of the beneficial effect in our study in contrast to that observed in the RECOVERY clinical trial may be due to biases in observational data, in particular prescription by indication bias, differences in clinical characteristics of patients, choice of corticosteroid used, timing of initiation of treatment, and duration of treatment.© Endocrine Society 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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