Implementation of corticosteroids in treating COVID-19 in the ISARIC WHO Clinical Characterisation Protocol UK: prospective observational cohort study

Fiina Narhi, Ramani Moonesinghe, Susan Deborah Shenkin, Thomas M. Drake, Rachel Mulholland, Cara Donegan, Jake Dunning , Cameron Fairfield, Michelle Girvan, Hayley E Hardwick, Antonia Ho, Gary Leeming, Jonathan S. Nguyen-Van-Tam, Riinu Pius, Clark D Russell, Catherine A Shaw, Rebecca G. Spencer, Lance Turtle, Peter J M Openshaw, Kenneth BaillieEwen M Harrison, Malcolm G Semple, Annemarie B Docherty

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)e220-e234
Number of pages15
JournalThe Lancet Digital Health
Volume4
Issue number4
Early online date22 Mar 2022
DOIs
Publication statusE-pub ahead of print - 22 Mar 2022

Keywords

  • Adolescent
  • Adrenal Cortex Hormones/therapeutic use
  • COVID-19/drug therapy
  • Cohort Studies
  • Female
  • Humans
  • Pregnancy
  • Prospective Studies
  • United Kingdom
  • World Health Organization

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