One 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 , Bakerly Nawar Diar , 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 AA 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 JM , 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: November 2023

Background

In patients with 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) one 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. HRQoL, assessed by EQ-5D-5L utility index, pre-hospital and one 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

In 1,888 participants included in the primary analysis, 1,149 received corticosteroids. There was no between-group difference in EQ-5D-5L utility index at one year (mean difference 0.004, 95% CI: -0.026 to 0.034,p= 0.77). A similar reduction in EQ-5D-5L was seen at one year between corticosteroid exposed and non-exposed groups (mean (SD) change -0.12 (0.22) vs -0.11 (0.22),p= 0.32). Overall, there were no differences in secondary outcome measures. After sensitivity analyses modelled using a larger cohort of 109,318 patients admitted to hospital with COVID-19, EQ-5D-5L utility index at one year remained similar between the two groups.

Interpretation

Systemic corticosteroids for acute COVID-19 have no impact on the large reduction in HRQoL one year after hospital discharge. Treatments to address this are urgently needed.

Take home message

Systemic corticosteroids given for acute COVID-19 do not affect health-related quality of life or other patient reported outcomes, physical and mental health outcomes, and organ function one year after hospital discharge