PDF(Pubmed)
Abstract：
OBJECTIVE: While glucocorticoid (GC) treatment initiated for COVID-19 reduces mortality, it is unclear whether GC treatment prior to COVID-19 affects mortality. Long-term GC use raises infection and thromboembolic risks. We investigated if patients with oral GC use prior to COVID-19 had increased mortality overall and by selected causes.
METHODS: Population-based observational cohort study.
METHODS: Population-based register data in Sweden.
METHODS: All patients infected with COVID-19 in Sweden from January 2020 to November 2021 (n=1 200 153).
METHODS: Any prior oral GC use was defined as ≥1 GC prescription during 12 months before index. High exposure was defined as ≥2 GC prescriptions with a cumulative prednisolone dose ≥750 mg or equivalent during 6 months before index. GC users were compared with COVID-19 patients who had not received GCs within 12 months before index. We used Cox proportional hazard models and 1:2 propensity score matching to estimate HRs and 95% CIs, controlling for the same confounders in all analyses.
RESULTS: 3378 deaths occurred in subjects with any prior GC exposure (n=48 806; 6.9%) and 14 850 among non-exposed (n=1 151 347; 1.3%). Both high (HR 1.98, 95% CI 1.87 to 2.09) and any exposure (1.58, 1.52 to 1.65) to GCs were associated with overall death. Deaths from pulmonary embolism, sepsis and COVID-19 were associated with high GC exposure and, similarly but weaker, with any exposure. High exposure to GCs was associated with increased deaths caused by stroke and myocardial infarction.
CONCLUSIONS: Patients on oral GC treatment prior to COVID-19 have increased mortality, particularly from pulmonary embolism, sepsis and COVID-19.
METHODS: Population-based observational cohort study.
METHODS: Population-based register data in Sweden.
METHODS: All patients infected with COVID-19 in Sweden from January 2020 to November 2021 (n=1 200 153).
METHODS: Any prior oral GC use was defined as ≥1 GC prescription during 12 months before index. High exposure was defined as ≥2 GC prescriptions with a cumulative prednisolone dose ≥750 mg or equivalent during 6 months before index. GC users were compared with COVID-19 patients who had not received GCs within 12 months before index. We used Cox proportional hazard models and 1:2 propensity score matching to estimate HRs and 95% CIs, controlling for the same confounders in all analyses.
RESULTS: 3378 deaths occurred in subjects with any prior GC exposure (n=48 806; 6.9%) and 14 850 among non-exposed (n=1 151 347; 1.3%). Both high (HR 1.98, 95% CI 1.87 to 2.09) and any exposure (1.58, 1.52 to 1.65) to GCs were associated with overall death. Deaths from pulmonary embolism, sepsis and COVID-19 were associated with high GC exposure and, similarly but weaker, with any exposure. High exposure to GCs was associated with increased deaths caused by stroke and myocardial infarction.
CONCLUSIONS: Patients on oral GC treatment prior to COVID-19 have increased mortality, particularly from pulmonary embolism, sepsis and COVID-19.
摘要：
目的：虽然开始对COVID-19进行糖皮质激素（GC）治疗可降低死亡率，目前尚不清楚COVID-19之前的GC治疗是否会影响死亡率。长期使用GC会增加感染和血栓栓塞风险。我们调查了在COVID-19之前口服GC的患者总体死亡率和选定原因是否增加。
方法：基于人群的观察性队列研究。
方法：瑞典基于人口的登记数据。
方法：2020年1月至2021年11月在瑞典感染COVID-19的所有患者（n=1,200,153）。
方法：任何先前的口服GC使用被定义为指数前12个月内≥1个GC处方。高暴露定义为指数前6个月内≥2张GC处方，累积泼尼松龙剂量≥750mg或等效剂量。将GC使用者与在指数前12个月内未接受GC的COVID-19患者进行比较。我们使用Cox比例风险模型和1：2倾向评分匹配来估计HR和95%CI，在所有分析中控制相同的混杂因素。
结果：3378例死亡发生在既往有GC暴露的受试者中（n=48806；6.9%），14850例未暴露者（n=1151347；1.3%）。高（HR1.98，95％CI1.87至2.09）和任何GCs暴露（1.58，1.52至1.65）均与总体死亡相关。肺栓塞死亡,脓毒症和COVID-19与高GC暴露有关，同样但较弱，任何曝光。高暴露于GCs与卒中和心肌梗死引起的死亡增加相关。
结论：在COVID-19之前口服GC治疗的患者死亡率增加，特别是肺栓塞，脓毒症和COVID-19。
方法：基于人群的观察性队列研究。
方法：瑞典基于人口的登记数据。
方法：2020年1月至2021年11月在瑞典感染COVID-19的所有患者（n=1,200,153）。
方法：任何先前的口服GC使用被定义为指数前12个月内≥1个GC处方。高暴露定义为指数前6个月内≥2张GC处方，累积泼尼松龙剂量≥750mg或等效剂量。将GC使用者与在指数前12个月内未接受GC的COVID-19患者进行比较。我们使用Cox比例风险模型和1：2倾向评分匹配来估计HR和95%CI，在所有分析中控制相同的混杂因素。
结果：3378例死亡发生在既往有GC暴露的受试者中（n=48806；6.9%），14850例未暴露者（n=1151347；1.3%）。高（HR1.98，95％CI1.87至2.09）和任何GCs暴露（1.58，1.52至1.65）均与总体死亡相关。肺栓塞死亡,脓毒症和COVID-19与高GC暴露有关，同样但较弱，任何曝光。高暴露于GCs与卒中和心肌梗死引起的死亡增加相关。
结论：在COVID-19之前口服GC治疗的患者死亡率增加，特别是肺栓塞，脓毒症和COVID-19。
