1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study
Authors: Leavy Olivia C. , Russell Richard J. , Harrison Ewen M. , Lone Nazir I. , Kerr Steven , Docherty Annemarie B. , Sheikh Aziz , Richardson Matthew , Elneima Omer , Greening Neil J. , Harris Victoria Claire , Houchen-Wolloff Linzy , McAuley Hamish J.C. , Saunders Ruth M. , Sereno Marco , Shikotra Aarti , Singapuri Amisha , Aul Raminder , Beirne Paul , Bolton Charlotte E. , Brown Jeremy S. , Choudhury Gourab , Diar Bakerly Nawar , Easom Nicholas , Echevarria Carlos , Fuld Jonathan , Hart Nick , Hurst John R. , Jones Mark , Parekh Dhruv , Pfeffer Paul , Rahman Najib M. , Rowland-Jones Sarah , Shah Ajay M. , Wootton Dan G. , Jolley Caroline , Thompson A.A. Roger , Chalder Trudie , Davies Melanie J. , De Soyza Anthony , Geddes John R. , Greenhalf William , Heller Simon , Howard Luke , Jacob Joseph , Jenkins R. Gisli , Lord Janet M. , Man Will D-C. , McCann Gerry P. , Neubauer Stefan , Openshaw Peter J.M. , Porter Joanna , Rowland Matthew J. , Scott Janet T. , Semple Malcolm G. , Singh Sally J. , Thomas David , Toshner Mark , Lewis Keir , Heaney Liam G. , Briggs Andrew , Zheng Bang , Thorpe Mathew , Quint Jennifer K. , Chalmers James D. , Ho Ling-Pei , Horsley Alex , Marks Michael , Poinasamy Krisnah , Raman Betty , Wain Louise V. , Brightling Christopher E. , Evans Rachael A. 
Published: August 2024

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±sdchange −0.12±0.22versus−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.