Association of Early Steroid Administration With Outcomes of Children Hospitalized for COVID-19 Without Multisystem Inflammatory Syndrome in Children
Authors: Tripathi Sandeep , Nadiger Meghana , McGarvey Jeremy S. , Harthan Aaron A. , Lombardo Monica , Gharpure Varsha P. , Perkins Nicholas , Chiotos Kathleen , Sayed Imran A. , Bjornstad Erica C. , Bhalala Utpal S. , Raju Umamaheswara , Miller Aaron S. , Dapul Heda , Montgomery Vicki , Boman Karen , Arteaga Grace M. , Bansal Vikas , Deo Neha , Tekin Aysun , Gajic Ognjen , Kumar Vishakha K. , Kashyap Rahul , Walkey Allan J. ,   Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group, Kovacevic Tanja , Markic Josko , Ardalic Tatjana Capitovic , Polic Branka , Ivić Ivo , Carev Dominko , Glavinic Robert , Vadgaonkar Girish , Ediga Rekha , Basety Shilpa , Dammareddy Shwetha , Kasumalla Phani Sreeharsha , Raju Umamaheswara , Manduva Janaki , Kolakani Naresh , Sripathi Shreeja , Chaitanya Sheetal , Papani Sridhar , Kamuram Mahesh , Mohan Surapaneni Krishna , Jyothisree Ekambaram , Petrolwala Mukur , Ladva Bharat , Itagaki Yuki , Kodate Akira , Suzuki Reina , Moriki Koyo , Hassan-Hanga Fatimah , Galadanci Hadiza , Gezawa Abubakar Shehu , Kabara Halima M. S. , Amole Taiwo Gboluwaga , Kabir Halima , Haliru Dalha Gwarzo , Ibrahim Abdullahi S , Asghar Muhammad Sohaib , Syed Mashaal , Naqvi Syed Anosh Ali , Yasmin Farah , Ahmed Iftekhar , Ishaque Sidra , Saleem Ali Faisal , Almazyad Mohammed A , Alarifi Mohammed I , Macarambon Jara M , Bukhari Ahmad Abdullah , Albahrani Hussain A. , Asfina Kazi N , Aldossary Kaltham M , Gharpure Varsha , Malki Walid , Cooper Paul , Kouzoukas Brenna , Jacobs Nekaiya , Ganbote Tejashree , Valentine Beryl , Sreerama Pavan , Havalad Vinod , Barry Suzanne , Woll Christopher , Wu Gregory , Carrole Erin , Burke Kathryn , Mohammed Mustafa , Irby Katherine , Sanders Ronald C. , Hefley Glenda , Christie Amy B , Ashley Dennis W , Adiga Rajani , Mosier Jarrod M , Lutrick Karen , Campbell Beth Salvagio , Wilson Cathleen , Rivers Patrick , Brinks Jonathan , Mongoh Mokenge Ndiva , Gilson Boris , Danesh Valerie C , Dubrocq Gueorgui , Davis Amber L , Hammers Marissa J , McGahey Ill M , Farris Amanda C , Priest Elisa , Korsmo Robyn , Fares Lorie , Skiles Kathy , Shor Susan M , Burns Kenya , Dowell Corrie A , Gonzales Gabriela “Hope” , Flores Melody , Newman Lindsay , Wilk Debora A , Ettlinger Jason , Bomar Jaccallene , Darji Himani , Arroliga Alejandro C , Khandhar Paras B. , Kring Elizabeth , Miller Aaron S. , Anderson Edwin L. , Nagy Rosemary , Inja Ravali R. , Nawathe Pooja A. , Pedraza Isabel , Tsing Jennifer , Carr Karen , Chaudhary Anila , Guglielmino Kathleen , Sayed Imran A. , Gist Katja M. , Strom Larisa , Chiotos Kathleen , Blatz Allison M. , Lee Giyoung , Burnett Ryan H. , Sydney Guy I. , Traynor Danielle M. , Cheruku Sreekanth , Ahmed Farzin , Deonarine Christopher , Jones Ashley , Shaikh Mohammad-Ali , Preston David , Chin Jeanette , Milligan Patrick S. , Gupta Sandeep K. , Koglin Joy M. , Gibson Regina , Johnson Lana , Preston Felicia , Scott Crimson , Nungester Bethany , Menter Sarah , Wasilewski Alex , Kaul Viren , Austin Praise , Rogner Jaimie , Russo  Anthony , Ontai Sidney , Contreras Brian , Obinwanko Uzoma , Amamasi Nneka , Sharafi Amir , Kaufman Margit , Lobel Gregg , Gandhi Nisha , Abdelaty Amr , Shaji Elizabeth , Lim Kiana , Marte Juan , Sosa Dani Ashley , Perkins Nicholas , Roth Prerana , Litwin Alain , Pariyadath Anand , Moschella Phillip , Llano Trayson , Rennert Lior , Dapul Heda R. , Salas Alan , Daube Ariel , Korn Michelle , Ramirez Michelle , Rajagopalan Logi , Santos Laura , Verma Sourabh , Crandall Christine , Stojanovski Sasko , Johnson Kristin , Michienzi Kelly , Amer Marwa Ridha , Bawazeer Mohammed Abdullah , Dahhan Talal I. , Kseibi Eiad , Butt Abid Shahzad , Khurshid Syed Moazzum , Rabee Muath , Abujazar Mohammed , Alghunaim Razan , Abualkhair Maal , AlFirm Abeer Turki , Gupta Manoj K , Oulds Franscene E. , Nandavar Akshay , Wen Andy Y. , DaCar Allie , Reilkoff Ronald A. , Heneghan Julia A. , Eichen Sarah , Goertzen Lexie , Rajala Scott , Feussom Ghislaine , Tang Ben , Kashyap Rahul , Domecq Juan Pablo , Gajic Ognjen , Bansal Vikas , Tekin Aysun , Lal Amos , O'Horo John C. , Deo Neha N. , Sharma Mayank , Qamar Shahraz , Singh Romil , Morales Diana J. Valencia , Khan Syed Anjum , Jain Nitesh Kumar , Koritala Thoyaja , Tarabichi Yasir , Perzynski Adam , Wang Christine , Kotekal Dhatri , Sendi Prithvi , Totapally Balagangadhar , Aulakh Bhagat S. , Tripathi Sandeep , Bandy Jennifer A. , Kreps Lisa M. , Bollinger Dawn R. , Nadiger Meghana , Schauf Victoria , Wall Chris , Menon Shina , McGuire John K , Rich Deana , Anderson Harry L. , Rajkumar Dixy , Abunayla Ali , Heiter Jerrilyn , Zaren Howard A. , Smith Stephanie J. , Lewis Grant C. , Seames Lauren , Farlow Cheryl , Miller Judy , Broadstreet Gloria , Lin John , Terrill Cindy , Montgomery Brock , Reyes Sydney , Reyes Summer , Plattner Alex , Martinez Anthony , Allison Micheal , Mittal Aniket , Ruiz Rafael , Skaanland Aleta , Ross Robert , Amzuta Ioana , Shah Amish , Modi Ritu , Al-Khalisy Hassan , Masuta Pardeep , Schafer Melissa , Wratney Angela , Gupta Neha , Jones Tracy L , Ayers Shonda C , Harrell Amy B , Brown Brent R , Brown Brent , Malone Kassidy , Sinko Lauren A , Hrarrell Amy B , Settle Lisa M. , Sears Taylor J , Bhalala Utpal S. , Kuehne Joshua , Garcia Melinda , Beebe Morgan , Herrera Heather , Belden Katherine A. , Baram Michael , Weber Devin M. , DePaola Rosalie , Xia Yuwei , Carter Hudson , Tolley Aaron , Ferranti Mary , Bjornstad Erica C. , Tofil Nancy M. , House Scott , Aldana Isabella , Stulce Casey W , Chong Grace , Ghavam Ahmeneh , Mayampurath Anoop , Bihorac Azra , Baslanti Tezcan Ozrazgat , Omalay George , Hashemighouchani Haleh , Cupka Julie S , Ruppert Matthew M , McGonagill Patrick W. , Galet Colette , Hubbard Janice , Wang David , Allan Lauren , Badheka Aditya , Chegondi Madhuradhar , Nazir Usman , Rampon Garrett , Riggle Jake , Dismang Nathan , Montgomery Vicki , Sullivan Janice , Morris Sarah , Nason Jennifer , Akhter Murtaza , Rahman Rania Abdul , Mulrow Mary , Kashiouris Markos G. , Gal Tamas , Mahashabde Manasi , Vagonis Alexandra , Uber Rebecca , Mahmud Haseeb , Leightle Stefan , Zhang Zoe , Vissichelli Nicole , Karam Oliver , O'Meara Alia , Carvalho Heloisa De , Rocawich Katie , Khanna Ashish K. , Harris Lynnette , Cusson Bruce , Reeves Brandon , Fanelli Jessica , Disher Nataya , Samant Anusha , DeGroot Chritian , Youshock Evan , Ligon R. Miller , McCartney Katherine , Garcia Julio , Iloabachie Chidi , Flores Kelsey , VanEenenaam David , Sands Lauren , Robinson Samuel , Sweatt Nia , Fowler Jacob , Fram Madeline , Howard Easton , Johnson Kathleen , Udoh Imoh , Nosow Lillian , Howard Lucy Winesett , Pham Quan Duc Minh , Irfanullah Aman , Ong Tiffany , Enwezor Chukwunyelu Henry , Dabagian Hannah , Mendoza Rafael 
Published: October 2022

Importance

There is limited evidence for therapeutic options for pediatric COVID-19 outside of multisystem inflammatory syndrome in children (MIS-C).

Objective

To determine whether the use of steroids within 2 days of admission for non–MIS-C COVID-19 in children is associated with hospital length of stay (LOS). The secondary objective was to determine their association with intensive care unit (ICU) LOS, inflammation, and fever defervescence.

Design, Setting, and Participants

This cohort study analyzed data retrospectively for children (&amp;lt;18 years) who required hospitalization for non–MIS-C COVID-19. Data from March 2020 through September 2021 were provided by 58 hospitals in 7 countries who participate in the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry.

Exposure

Administration of steroids within 2 days of admission.

Main Outcomes and Measures

Length of stay in the hospital and ICU. Adjustment for confounders was done by mixed linear regression and propensity score matching.

Results

A total of 1163 patients met inclusion criteria and had a median (IQR) age of 7 years (0.9-14.3). Almost half of all patients (601/1163, 51.7%) were male, 33.8% (392/1163) were non-Hispanic White, and 27.9% (324/1163) were Hispanic. Of the study population, 184 patients (15.8%) received steroids within 2 days of admission, and 979 (84.2%) did not receive steroids within the first 2 days. Among 1163 patients, 658 (56.5%) required respiratory support during hospitalization. Overall, patients in the steroids group were older and had greater severity of illness, and a larger proportion required respiratory and vasoactive support. On multivariable linear regression, after controlling for treatment with remdesivir within 2 days, country, race and ethnicity, obesity and comorbidity, number of abnormal inflammatory mediators, age, bacterial or viral coinfection, and disease severity according to ICU admission within first 2 days or World Health Organization ordinal scale of 4 or higher on admission, with a random intercept for the site, early steroid treatment was not significantly associated with hospital LOS (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Separate analyses for patients with an LOS of 2 days or longer (n = 729), those receiving respiratory support at admission (n = 286), and propensity score–matched patients also showed no significant association between steroids and LOS. Early steroid treatment was not associated with ICU LOS, fever defervescence by day 3, or normalization of inflammatory mediators.

Conclusions and Relevance

Steroid treatment within 2 days of hospital admission in a heterogeneous cohort of pediatric patients hospitalized for COVID-19 without MIS-C did not have a statistically significant association with hospital LOS.