Corticosteroids and long-term pulmonary function after critical illness due to COVID-19– a single-center cohort study

TL;DR

This study found that corticosteroid treatment for critical COVID-19 may lead to reduced lung function six months later, though it did not affect quality of life.

Contribution

The study is the first to report long-term pulmonary effects of corticosteroids in critical COVID-19 patients.

Findings

Corticosteroid-treated patients had lower diffusion capacity for carbon monoxide six months post-ICU discharge.

There was no significant difference in health-related quality of life between corticosteroid-treated and untreated patients.

The observed decrease in lung function was clinically significant (>10% change).

Abstract

Early in the pandemic, corticosteroids became standard treatment for patients with critical COVID-19 infections. This study aimed to investigate the possible long-term pulmonary consequences after corticosteroid treatment in patients with critical COVID-19 requiring ventilatory support.

This observational single-center cohort study included patients treated for critical COVID-19 requiring ventilatory support between March 1, 2020, and August 1, 2021, with a 6-month follow-up after discharge from the intensive care unit. Corticosteroid treatment was defined according to the RECOVERY trial (6 mg dexamethasone daily or equivalent dose of another corticosteroid, initiated within eight days of hospital admittance and continued for at least one day) Pulmonary function was assessed by diffusion capacity for carbon monoxide. Health-related quality of life was measured with the questionnaire RAND-36. General linear regression was used to present mean score differences with 95% confidence intervals.

Among the 456 (69%) critically ill COVID-19 patients who survived at least 90 days after ICU discharge, 286 (63%) attended the follow-up six months later. The groups were balanced regarding invasive ventilation; 47% received invasive ventilation in both groups. Corticosteroid treatment was associated with a lower diffusion capacity for carbon monoxide (MSD − 8.3, 95% CI: -14.2 to -2.4) 6 months after ICU discharge (change > 10% were regarded as clinically significant). There were no differences in health-related quality of life between the groups.

Corticosteroids might negatively impact pulmonary function after critical COVID-19. The decrease did not seem to influence health-related quality of life. Future studies are needed to confirm the results.

The online version contains supplementary material available at 10.1186/s12890-025-03659-0.

Figures