14-Day survival among older adults with severe SARS-Cov2 infection treated with corticosteroid: a cohort study.

Abstract (248 words) Objective To assess the effectiveness of corticosteroids among older adults with COVID-19 pneumonia requiring oxygen. Methods We used routine care data from 36 hospitals in France and Luxembourg to assess the effectiveness of corticosteroids at 0.4 mg/kg/day eq. prednisone (treatment group) versus standard of care (control group) among adults ≥ 80 years old with PCR-confirmed SARS-CoV-2 infection or CT-scan images typical of COVID-19 pneumonia, requiring oxygen ≥ 3 L/min, and with an inflammatory syndrome (C-reactive protein ≥ 40 mg/L). The primary outcome was overall survival at day 14. In our main analysis, characteristics of patients at baseline (i.e., time when patients met all inclusion criteria) were balanced by using propensity-score inverse probability of treatment weighting. Results Among the 267 patients included in the analysis, 98 were assigned to the treatment group. Their median age was 86 years (interquartile range 83 to 90), and 95% had a SARS-CoV-2 PCR-confirmed diagnosis. In total, 43/98 (43.9%) patients in the treatment group and 84/166 (50.6%) in the control group died before day 14 (weighted hazard ratio [wHR] 0.67, 95% CI 0.46 to 0.99). The treatment and control groups did not differ significantly for the proportion of patients discharged to home/rehabilitation at day 14 (wRR 1.12, 95% CI 0.68 to 1.82). Twenty-two (16.7%) patients receiving corticosteroids developed adverse events, but only 11 (6.4%) from the control group. Conclusions Corticosteroids were associated with a significant increase in the overall survival at day 14 of patients aged 80 years and older hospitalised for severe COVID-19.