# The Impact of Corticosteroid Therapy on Patients With West Nile Virus: A Retrospective Cohort Study

## TL;DR

A study of 150 West Nile virus patients found that early corticosteroid use was linked to higher hospital mortality, suggesting potential harm.

## Contribution

This is the first study to show an association between corticosteroid therapy and increased mortality in West Nile virus patients.

## Key findings

- Corticosteroid treatment was linked to a 3.93-fold higher risk of hospital mortality after adjusting for confounders.
- Results were consistent in sensitivity analyses focusing on neuroinvasive disease and longer hospital stays.
- The study highlights the need for caution in using corticosteroids during acute West Nile virus infection.

## Abstract

West Nile virus (WNV) infection may result in a serious, neuroinvasive, life-threatening disease. Since there is no known therapy against the virus, treatment is based on supportive care. Little is known about the effect of corticosteroids (CS) in patients with West Nile, and their use remains controversial. This study aimed to evaluate the effect of CS treatment in patients with WNV infection.

A retrospective cohort study was conducted at Rabin Medical Center, including patients with WNV infection. Data were extracted from patients’ electronic medical records. Inverse probability of treatment weighting was used to adjust patient characteristics. Our exposure of interest was CS prescription during the first 48 hours. IPTW-adjusted Cox proportional hazard models were used to compare the risk of hospital mortality. Secondary outcomes included the need for mechanical ventilation or intensive care unit transfer, and the need for rehabilitation or a long-term care facility at discharge.

Data from 150 confirmed cases were extracted. 41 (27%) patients received CSs. After adjusting for potential confounders, CS treatment was found to significantly increase hospital mortality (adjusted hazard ratio [aHR] 3.93, 95% confidence interval [CI] 1.14–13.51). A sensitivity analysis including patients with West Nile neuroinvasive disease and patients hospitalized for more than 48 hours showed consistent results.

Our study suggests that CS use in WNV patients may be associated with an increased risk of hospital mortality, highlighting the need for caution in their use and further prospective investigation.

In a 2024 Israeli cohort of 150 hospitalized West Nile virus patients, early corticosteroid therapy was associated with increased hospital mortality, suggesting potential harm and underscoring the need for caution in corticosteroid use during acute viral infection.

Graphical abstractThis graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/the-impact-of-corticosteroid-therapy-on-west-nile-virus-infected-patients-a-retrospective-cohort-study?utm_campaign=tidbitlinkshare&utm_source=IO

This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/the-impact-of-corticosteroid-therapy-on-west-nile-virus-infected-patients-a-retrospective-cohort-study?utm_campaign=tidbitlinkshare&utm_source=IO