TY - JOUR
T1 - Implementation of corticosteroids in treatment of COVID-19 in the ISARIC WHO Clinical Characterisation Protocol UK
T2 - prospective, cohort study
AU - ISARIC4C Investigators
AU - Närhi, Fiina
AU - Moonesinghe, S. Ramani
AU - Shenkin, Susan D.
AU - Drake, Thomas M.
AU - Mulholland, Rachel H.
AU - Donegan, Cara
AU - Dunning, Jake
AU - Fairfield, Cameron J.
AU - Girvan, Michelle
AU - Hardwick, Hayley E.
AU - Ho, Antonia
AU - Leeming, Gary
AU - Nguyen-Van-Tam, Jonathan S.
AU - Pius, Riinu
AU - Russell, Clark D.
AU - Shaw, Catherine A.
AU - Spencer, Rebecca G.
AU - Turtle, Lance
AU - Openshaw, Peter J.M.
AU - Baillie, J. Kenneth
AU - Harrison, Ewen M.
AU - Semple, Malcolm G.
AU - Docherty, Annemarie B.
AU - Openshaw, Peter JM
AU - Carson, Gail
AU - Alex, Beatrice
AU - Andrikopoulos, Petros
AU - Bach, Benjamin
AU - Barclay, Wendy S.
AU - Bogaert, Debby
AU - Chand, Meera
AU - Chechi, Kanta
AU - Cooke, Graham S.
AU - da Silva Filipe, Ana
AU - de Silva, Thushan
AU - dos Santos Correia, Gon¸alo
AU - Dumas, Marc Emmanuel
AU - Fletcher, Tom
AU - Green, Christopher A.
AU - Greenhalf, William
AU - Griffin, Julian
AU - Gupta, Rishi K.
AU - Hiscox, Julian A.
AU - Ho, Antonia YW
AU - Horby, Peter W.
AU - Ijaz, Samreen
AU - Khoo, Say
AU - Klenerman, Paul
AU - Zambon, Maria
AU - Metelmann, Soeren
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2022/4
Y1 - 2022/4
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85126656095&partnerID=8YFLogxK
U2 - 10.1016/S2589-7500(22)00018-8
DO - 10.1016/S2589-7500(22)00018-8
M3 - Article
AN - SCOPUS:85126656095
SN - 2589-7500
VL - 4
SP - e220-e234
JO - The Lancet Digital Health
JF - The Lancet Digital Health
IS - 4
ER -