Increased secondary infection in COVID-19 patients treated with steroids in New York City

Abstract

Since cytokine release syndrome is considered to be associated with severe cases of COVID-19, steroids are expected to be effective for its treatment. We aimed to investigate the use of steroids and its impact. We conducted a retrospective chart review and analysis of 226 consecutive hospitalized patients with confirmed COVID-19. Patients were divided into those who received steroids (steroid group) and those who did not (no steroid group). Inverse weighted probability weighted analysis was performed to assess the effect of steroids for in-hospital mortality. The steroid group had higher rates of preexisting hypertension and peripheral vascular disease than no steroid group and also had higher lactate dehydrogenase, d-dimer, and inflammatory makers compared to no steroid group (all P<0.05). The steroid group had significantly higher rates of multifocal pneumonia than no steroid group at admission (75.4% versus 50.3%, P=0.001). Notably, steroid group had higher rates of bacterial infection (25% versus 13.1%, P=0.041) and fungal infection (12.7% versus 0.7%, P<0.001) during hospital course. After adjustment, steroid did not decrease or increase in-hospital mortality (OR [95% CI]: 1.02 [0.60-1.73, P=0.94]). Steroid did not decrease the in-hospital mortality rate. There were increased bacterial and fungal infections with steroid use.