{Reference Type}: Observational Study
{Title}: Impact of chronic oral glucocorticoid treatment on mortality in patients with COVID-19: analysis of a population-based cohort.
{Author}: Einarsdottir MJ;Kibiwott Kirui B;Li H;Olsson D;Johannsson G;Nyberg F;Ragnarsson O;
{Journal}: BMJ Open
{Volume}: 14
{Issue}: 3
{Year}: 2024 Mar 15
{Factor}: 3.006
{DOI}: 10.1136/bmjopen-2023-080640
{Abstract}: <B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>Population-based observational cohort study.<BR><B>METHODS: </B>Population-based register data in Sweden.<BR><B>METHODS: </B>All patients infected with COVID-19 in Sweden from January 2020 to November 2021 (n=1 200 153).<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>Patients on oral GC treatment prior to COVID-19 have increased mortality, particularly from pulmonary embolism, sepsis and COVID-19.