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Increased Secondary Infection in COVID-19 Patients Treated with Steroids in New York City
Reiichiro Obata1, Tetsuro Maeda1, Dahlia Rizk1
1Department of Medicine, Icahn School of Medicine at Mount Sinai, USA.
Insights
Steroids did not impact in-hospital mortality for COVID-19 patients. However, steroid use was associated with increased rates of bacterial and fungal infections during hospitalization.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Cytokine release syndrome is a severe complication of coronavirus disease 2019 (COVID-19).
- Steroids are hypothesized to be effective in managing severe COVID-19 and associated cytokine release syndrome.
Purpose of the Study:
- To investigate the effect of steroid administration on in-hospital mortality in COVID-19 patients.
- To evaluate the association between steroid use and the incidence of secondary infections.
Main Methods:
- Retrospective chart review of 226 hospitalized COVID-19 patients.
- Patients categorized into steroid and no-steroid groups.
- Inverse probability weighted analysis to adjust for confounding factors.
Main Results:
- Steroid group exhibited higher rates of comorbidities and inflammatory markers.
- Increased incidence of bacterial (25% vs 13.1%) and fungal (12.7% vs 0.7%) infections in the steroid group.
- Steroid use was not significantly associated with in-hospital mortality (OR 1.02, P=0.94).
Conclusions:
- Steroid treatment did not alter in-hospital mortality for COVID-19 patients.
- Steroid administration is linked to a higher risk of developing bacterial and fungal infections.
Abstract:
Steroids are expected to be effective in the treatment of cytokine release syndrome, which is considered to be associated with severe cases of coronavirus disease 2019 (COVID-19). We aimed to investigate the use of steroids and its effects. We conducted a retrospective chart review and an analysis of 226 consecutive hospitalized patients with confirmed COVID-19. Patients were divided into those who received steroids (steroid group) and those who did not (no steroid group). Inverse probability weighted analysis was performed to assess the effect of steroids on in-hospital mortality. The steroid group had higher rates of preexisting hypertension and peripheral vascular disease as well as higher lactate dehydrogenase levels, d-dimer levels, and inflammatory markers than the no steroid group (all P <0.05). The steroid group had significantly higher rates of multifocal pneumonia than the no steroid group at admission (75.4% vs. 50.3%, P = 0.001). Notably, the steroid group had higher rates of developing bacterial infection (25% vs. 13.1%, P = 0.041) and fungal infection (12.7% versus 0.7%, P <0.001) during the hospital course than the no steroid group. After adjustment, it was observed that steroids did not decrease or increase in-hospital mortality (odds ratio [95% confidence interval]: 1.02 [0.60-1.73, P = 0.94]). There was an increase in bacterial and fungal infections with steroid use.
