# Outpatient glucocorticoid use and COVID-19 outcomes: a population-based study

## TL;DR

Using glucocorticoids as an outpatient increases the risk of severe outcomes from COVID-19, including hospitalization and death.

## Contribution

This study provides real-world evidence linking outpatient glucocorticoid use to worse outcomes in patients with COVID-19.

## Key findings

- Outpatient glucocorticoid use was associated with increased hospitalization risk (aOR 1.79).
- Higher doses and recent use were linked to a fourfold increase in mortality (aOR 3.85).
- Glucocorticoid use also increased susceptibility to infection (aOR 1.29).

## Abstract

Owing to controversy information surrounds effect of glucocorticoids on the evolution of COVID-19, we evaluate the effects of outpatient glucocorticoid use on the severity and progression of COVID-19 and risk of infection and analyse the effect of window of exposure and dose.

We conducted a population-based case − control study, involving 4 substudies: (i) Hospitalisation; (ii) Mortality, using subjects hospitalised with a PCR + as cases and subjects without a PCR + as controls; (iii) Progression, including subjects with a PCR + (hospitalised versus non-hospitalised); and (iv) Susceptibility, with all subjects with a PCR + and subjects without a PCR + . Adjusted odds ratios (ORa) and their 95% confidence intervals (95% CI) were calculated.

The outpatient glucocorticoid use was associated with an increased risk of hospitalisation (aOR 1.79; 95% CI 1.56–2.05), mortality (aOR 2.30; 95% CI 1.68–3.15), progression (aOR 1.69; 95% CI 1.43–2.00) and susceptibility (aOR 1.29, 95% CI 1.19–1.41). Furthermore, the effects was observed to be greater at higher doses and the closer that drug use approached the outcome date, with an almost fourfold increase in mortality among users in the previous month (aOR 3.85; 95% CI 2.63–5.62).

According to the results of this real-world data study, outpatient glucocorticoid use should be considered in making decisions about intrahospital treatment.

The online version contains supplementary material available at 10.1007/s10787-024-01474-3.