Implementation of corticosteroids in treatment of COVID-19 in the ISARIC WHO Clinical Characterisation Protocol UK: prospective, cohort study.
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
BACKGROUND: Dexamethasone was the first intervention proven to reduce mortality in patients with COVID-19 being treated in hospital. We aimed to evaluate the adoption of corticosteroids in the treatment of COVID-19 in the UK after the RECOVERY trial publication on June 16, 2020, and to identify discrepancies in care. METHODS: We did an audit of clinical implementation of corticosteroids in a prospective, observational, cohort study in 237 UK acute care hospitals between March 16, 2020, and April 14, 2021, restricted to patients aged 18 years or older with proven or high likelihood of COVID-19, who received supplementary oxygen. The primary outcome was administration of dexamethasone, prednisolone, hydrocortisone, or methylprednisolone. This study is registered with ISRCTN, ISRCTN66726260. FINDINGS: Between June 17, 2020, and April 14, 2021, 47 795 (75·2%) of 63 525 of patients on supplementary oxygen received corticosteroids, higher among patients requiring critical care than in those who received ward care (11 185 [86·6%] of 12 909 vs 36 415 [72·4%] of 50 278). Patients 50 years or older were significantly less likely to receive corticosteroids than those younger than 50 years (adjusted odds ratio 0·79 [95% CI 0·70-0·89], p=0·0001, for 70-79 years; 0·52 [0·46-0·58], p<0·0001, for >80 years), independent of patient demographics and illness severity. 84 (54·2%) of 155 pregnant women received corticosteroids. Rates of corticosteroid administration increased from 27·5% in the week before June 16, 2020, to 75-80% in January, 2021. INTERPRETATION: Implementation of corticosteroids into clinical practice in the UK for patients with COVID-19 has been successful, but not universal. Patients older than 70 years, independent of illness severity, chronic neurological disease, and dementia, were less likely to receive corticosteroids than those who were younger, as were pregnant women. This could reflect appropriate clinical decision making, but the possibility of inequitable access to life-saving care should be considered. FUNDING: UK National Institute for Health Research and UK Medical Research Council.
Date Issued
2022-04
Date Acceptance
2022-01-13
Citation
The Lancet Digital Health, 2022, 4 (4), pp.e220-e234
ISSN
2589-7500
Publisher
Elsevier
Start Page
e220
End Page
e234
Journal / Book Title
The Lancet Digital Health
Volume
4
Issue
4
Copyright Statement
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0
license.
license.
License URL
Sponsor
UK Research and Innovation
National Institute for Health Research
National Institute for Health Research
UKRI MRC COVID-19 Rapid Response Call
UK Research and Innovation
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/35337642
PII: S2589-7500(22)00018-8
Grant Number
9815274 MC_PC_19025
HPRU-2012-10064
NIHR201385
MC_PC19025
1257927
Subjects
Adolescent
Adrenal Cortex Hormones
COVID-19
Cohort Studies
Female
Humans
Pregnancy
Prospective Studies
United Kingdom
World Health Organization
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2022-03-22