Abstract

Background: Corticosteroids are the standard of care for SAH in the absence of contraindications. Survival benefits conferred by steroids are often gained at the expense of increased infection risk. We investigated the co-incidental impact of infection mitigation measures during the COVID pandemic on mortality in SAH patients treated with corticosteroids.

Methods: Data from 5 recent clinical studies were combined, 3 of which were conducted before the COVID outbreak, one during the pandemic, and one included a timeframe before and during the COVID. April 1, 2020 was defined as the start of COVID-19 outbreak period because the ongoing studies stopped recruitment in the early months of the pandemic. Mortality rates at 28, 90, and 180 days were compared between the pre and during-COVID pandemic periods in patients treated with corticosteroids. Cox regression analyses were performed to compare the survival while controlling for patient characteristics.

Results: Data from 575 patients (415 from pre-COVID and 160 during COVID) were analyzed. Patients recruited during the COVID pandemic were slightly younger (43.7 vs. 46.5 in the pre-COVID period). Mean MELD scores were similar (25.7 for pre-and 24.8 for during-COVID periods). Mortality rates at 28 (11.6% vs 2.5%), 90 (22.4% vs 10%), and 180 (26.5% vs 15%) days were consistently higher for the pre-pandemic period (Figure 1A). Estimated survival probabilities were significantly higher during the pandemic (Figure 1B). After controlling for MELD and patient characteristics, the adjusted hazard ratios of the during-COVID period for 28, 90, and 180-days survival were 0.28 (95%CI [0.1,0.79]), 0.51 ([0.3,0.87]), and 0.57 ([0.36,0.89]), respectively (all p<0.05).

Conclusion: The markedly lower mortality rates in SAH patients treated with steroids after the COVID outbreak raise the possibility that infection mitigation measures enacted during the pandemic may have collaterally benefited patients on corticosteroid therapy.