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Impact of chronic oral glucocorticoid treatment on mortality in patients with COVID-19: analysis of a

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Area of Science:

  • Clinical Medicine
  • Epidemiology
  • Pharmacology

Background:

  • Glucocorticoid (GC) treatment during COVID-19 reduces mortality.
  • Long-term GC use is linked to increased infection and thromboembolic risks.
  • The impact of pre-existing GC use on COVID-19 mortality remains unclear.

Purpose of the Study:

  • To investigate if oral GC use prior to COVID-19 infection is associated with increased all-cause and cause-specific mortality.
  • To evaluate the mortality risks associated with different levels of prior GC exposure.

Main Methods:

  • Population-based observational cohort study using Swedish register data (January 2020 - November 2021).
  • Included 1,200,153 patients infected with COVID-19.
  • Compared mortality between patients with any prior oral GC use (≥1 prescription in 12 months) or high exposure (≥2 prescriptions, ≥750mg prednisolone equivalent in 6 months) versus unexposed patients.
  • Utilized Cox proportional hazard models and propensity score matching.

Main Results:

  • 33,780 deaths occurred among 48,806 patients with any prior GC exposure (6.9%), versus 14,850 among 1,151,347 unexposed patients (1.3%).
  • Both any GC exposure (HR 1.58) and high GC exposure (HR 1.98) were associated with increased overall mortality.
  • High GC exposure was linked to higher mortality from pulmonary embolism, sepsis, COVID-19, stroke, and myocardial infarction.

Conclusions:

  • Oral GC treatment prior to COVID-19 infection is associated with increased overall mortality.
  • The increased mortality risk is particularly evident for deaths due to pulmonary embolism, sepsis, and COVID-19.
  • Higher GC exposure levels correlate with greater mortality risks.