In-hospital mortality in SARS-CoV-2 stratified by the use of corticosteroid

Naser Alotaibi; Moudhi Alroomi; Wael Aboelhassan; Soumoud Hussein; Rajesh Rajan; Noor AlNasrallah; Mohammad Al Saleh; Maryam Ramadhan; Kobalava D Zhanna; Jiazhu Pan; Haya Malhas; Hassan Abdelnaby; Farah Almutairi; Bader Al-Bader; Ahmad Alsaber; Mohammed Abdullah

doi:10.1016/j.amsu.2022.104105

In-hospital mortality in SARS-CoV-2 stratified by the use of corticosteroid

Ann Med Surg (Lond). 2022 Aug:80:104105. doi: 10.1016/j.amsu.2022.104105. Epub 2022 Jun 29.

Authors

Naser Alotaibi¹, Moudhi Alroomi², Wael Aboelhassan³, Soumoud Hussein⁴, Rajesh Rajan⁵, Noor AlNasrallah¹, Mohammad Al Saleh⁶, Maryam Ramadhan⁷, Kobalava D Zhanna⁸, Jiazhu Pan⁹, Haya Malhas¹⁰, Hassan Abdelnaby^{11

12}, Farah Almutairi⁶, Bader Al-Bader⁶, Ahmad Alsaber⁹, Mohammed Abdullah²

Affiliations

¹ Department of Medicine, Al Adan Hospital, Hadiya, Kuwait.
² Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait.
³ Division of Gastroenterology, Department of Medicine, Jaber Al Ahmed Hospital, South Surra, Kuwait.
⁴ Department of Medicine, Al Amiri Hospital, Kuwait City, Kuwait.
⁵ Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait.
⁶ Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait.
⁷ Department of Obstetrics and Gynaecology, Maternity Hospital, Shuwaikh Medical Area, Kuwait.
⁸ Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation.
⁹ Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom.
¹⁰ Department of Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait.
¹¹ Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
¹² Division of Gastroenterology, Department of Medicine, Al Sabah Hospital, Shuwaikh Medical Area, Kuwait.

Abstract

Objective: To investigate COVID-19 related mоrtаlity according to the use of corticosteroid therapy.

Design: Retrospective cohort study.

Setting: Two tertiary hospitals in Kuwait.

Participants: Overall, 962 patients with confirmed SARS-CoV-2 infection, were stratified according to whether they were treated with corticosteroids (dexamethasone or methylprednisolone). The mean age of the patients was 50.2 ± 15.9 years and 344/962 (35.9%) were female.

Main outcome measures: In-hospital mortality and cumulative all-cause mortality.

Results: Compared to non-corticosteroid therapy patients, corticosteroid therapy patients had a higher prevalence of hypertension, diabetes mellitus, cardiovascular disease, chronic lung disease, and chronic kidney disease; a longer hospital stay (median [IQR]: 17.0 [5.0-57.3] days vs 14.0 [2.0-50.2] days); and a higher in-hospital mortality (51/199 [25.6%] vs 36/763 [4.7%]). Logistic regression analysis showed a higher in-hospital mortality in the corticosteroid group (adjusted odds ratio [aOR]: 4.57, 95% confidence interval [CI]: 2.64-8.02, p < 0.001). Cox proportional hazards regression showed that corticosteroid use was a significant predictor of mortality (hazard ratio [HR]: 3.96, p < 0.001).

Conclusions: In-hospital mortality in patients with SARS-CoV-2 on corticosteroid therapy was 4.6 times higher than in those without corticosteroid therapy.

Keywords: Age; COVID-19; Corticosteroids; In-hospital mortality; SARS-COV-2.