High-dose corticosteroid use in patients with severe to critical COVID-19 improves survival but increases COVID-19-associated pulmonary aspergillosis: a nationwide population-based study.

배경: Systemic corticosteroids have become the standard of care for patients with severe to critical coronavirus disease 2019 (COVID-19). However, the real-world efficacy and safety outcomes of a higher dose of corticosteroids remain uncertain. This study aimed to determine the impact of higher dose corticosteroids on the survival and development of COVID-19-associated pulmonary aspergillosis (CAPA). 방법: We conducted a nationwide, population-based study using the National Health Information Database between January 2020 and June 2021. Adult patients with severe to critical COVID-19 were enrolled. The high-dose corticosteroid group included patients who received more than 60 mg of dexamethasone or an equivalent dose over 10 days. Analyses were performed using both a propensity-score matched cohort and an entire cohort. 결과: During the study period, 102,304 patients were screened, 10,417 met the eligibility criteria, and 2,457 were successfully matched. High-dose corticosteroid use significantly reduced all-cause mortality at 28 days (hazard ratios [HRs], 0.543; confidence intervals [CIs], 0.475–0.619), but increased the risk of CAPA (HRs, 5.824; CIs, 2.260–15.008). As a prespecified exploratory outcome, all-cause mortality at 90 days was lower and mechanical ventilation (MV) free days at 28 days were longer in the high-dose corticosteroid group (all p < 0.05). However, there was no difference in the rate of MV applying at 28 days, and all-cause mortality according to the development of CAPA. 결론: Among patients with severe to critical COVID-19, higher dose corticosteroids resulted in a decrease in all-cause mortality at 28 and 90 days but the risk of CAPA development increased. Clinical awareness and active surveillance for CAPA should be needed to avoid associated unfavorable outcomes. [ABSTRACT FROM AUTHOR]