Common steroids after hospital discharge for covid can reduce the risk of death


New research has shown that severe inflammation during hospitalization for Covid-19 increases the risk of death within a year of apparent recovery by 61%, but this risk is mitigated if anti-inflammatory steroids are prescribed at discharge. For this reason, the authors affirm in the journal ‘Frontiers in Medicine’ that Covid-19 should be considered as a potentially chronic disease that requires long-term treatment.

Evidence continues to accumulate that “long Covid”, i.e. the continuation of negative health effects months after apparent recovery from severe Covid-19, is a significant risk for some patients. For example, researchers from the University of Florida (United States) showed last December that hospitalized patients who have apparently recovered from severe Covid-19 are more than twice as likely to die in the following year, compared to those people who experienced only mild or moderate symptoms and who had not been hospitalized, or who never contracted the disease.

Now, a team including some of the same authors shows, for the first time, that among hospitalized Covid-19 patients who appear to have recovered, severe systemic inflammation during their hospitalization is a risk factor for death within one year.

This may seem paradoxical, since inflammation is a natural part of the body’s immune response, which has evolved to fight infection. But in some diseases, like Covid-19, this response can be overwhelmed, causing more damage.

“Covid-19 is known to create inflammation, especially during the first acute episode. Our study is the first to examine the relationship between inflammation during hospitalization for Covid-19 and mortality after the patient has ‘recovered’.” , says first author Professor Arch G Mainous III, vice chair for research in the Department of Community Health and Family Medicine at the University of Florida Gainesville.

“Here we show that the stronger the inflammation during the initial hospitalization, the greater the probability that the patient will die in the 12 months following their apparent ‘recovery’ from Covid-19,” he highlights.

Mainous and colleagues studied the de-identified electronic health records of 1,207 adults hospitalized in 2020 or 2021 after testing positive for COVID-19 within the University of Florida Health System, and who had been followed for at least one year after discharge. .

As an indicator of the severity of systemic inflammation during hospitalization, they used a common and validated measure, the blood concentration of the molecule C-reactive protein (CRP), secreted by the liver in response to a signal from active immune cells.

As expected, blood CRP concentration during hospitalization was strongly correlated with Covid-19 severity: 59.4 mg/L for hospitalized patients who did not require supplemental oxygen, 126.9 mg/L for those who did. they required additional oxygen by noninvasive and nonmechanical ventilation, and 201.2 mg/L for the most severe cases, which required ventilation by ventilator or by extracorporeal membrane oxygenation.

Covid-19 patients with the highest CRP concentration measured during their hospital stay had a 61% higher risk – corrected for other risk factors – of dying from any cause within one year of hospital discharge than patients with the lowest concentration of CRP.

“Many infectious diseases are accompanied by increased inflammation,” Mainous says. “Most of the time, inflammation is localized or specific to where the infection is. Covid-19 is different because it creates inflammation in many places besides the airways, for example in the heart, brain and kidneys. A high degree of inflammation can lead to tissue damage.”

The authors showed that the elevated risk of death from any cause associated with severe inflammation was further reduced by 51% if the patient was prescribed anti-inflammatory steroids after hospitalization.

These results mean that the severity of inflammation during hospitalization for Covid-19 can predict the risk of later serious health problems, including death, from long Covid. They also imply that current best practice recommendations may need to be changed to include more widespread prescription of oral steroids to Covid-19 patients after discharge.

The authors propose that Covid-19 be considered a potentially chronic disease. “When someone has a cold or even pneumonia, we tend to think that the disease is over once the patient recovers. This is different from a chronic disease, such as congestive heart failure or diabetes, which continue to affect patients after of an acute episode,” Mainous warns. “We may also have to start thinking that Covid-19 has ongoing effects on many parts of the body after patients have recovered from the initial episode.”

“Once we recognize the importance of Covid long after apparent ‘recovery,’ we need to focus on treatments to prevent later problems, such as stroke, brain dysfunction, and especially early death,” he concludes.