Assessing Incidence of Patients with Secondary Infection in COVID-19 Pneumonia who was Received Corticosteroid Treatment in Samutprakarn Hospital

Abstract

BACKGROUND: Corticosteroids are an anti-inflammatory drug that plays an important role in the treatment and reduced death rate of patients with severe pneumonia from COVID-19. However, corticosteroids increase the chance of secondary infection due to reduced immunity. Therefore, using corticosteroids to treat patients with severe pneumonia from COVID-19 could have affected the rate of secondary infection and the death rate of patients at Samut Prakarn Hospital.

OBJECTIVE: This study aimed to determine the rate of secondary infection, death rate, and important risk factors affecting the death rate in patients with severe pneumonia from COVID-19 who received corticosteroids at Samut Prakarn Hospital. A secondary objective was to assess whether the different doses of corticosteroids these patients received had any effect on secondary infections or death rates.

METHODS: This study utilized a retrospective approach (retrospective cohort study) by selecting patients who met the criteria and reviewing information from medical records of patients diagnosed with severe pneumonia from COVID-19 who received corticosteroid medication. A total of 675 patients were admitted to Samut Prakarn Hospital from 1 June to 30 September 2021. Statistical analysis included descriptive statistics, univariable and multivariable logistic regression analysis, and chi-square test.

RESULTS: The total secondary infection rate was 26.8%. The most common secondary infection was in the respiratory system, accounting for 22.5%. The mortality rate was 42.2% (95%CI=38.5-46%). Corticosteroid doses of 10 mg, 16 mg, and 20 mg resulted in secondary infection rates of 5%, 56.9%, and 38.1%, respectively. Corticosteroid doses of 16 mg and 20 mg were associated with higher rates of secondary infections compared to the 10 mg dose, with p-values of 0.049 and 0.021, respectively. When secondary infections occurred, the mortality rate was significantly higher, with an adjusted odds ratio of 3.01 (95%CI=2.03-4.45). From this study, it was found that patients with severe pneumonia from COVID-19 who had risk factors such as being over 60 years old, a history of stroke, and chronic kidney failure had an increased death rate.

CONCLUSION: This study found that patients with severe pneumonia from COVID-19 receiving corticosteroids may experience secondary infections as a side effect. Further, the mortality rate is significantly higher when secondary infections occur. In this study, corticosteroid doses of 16 mg and 20 mg increased the chance of secondary infection compared to the 10 mg dose. However, the death rate did not differ among the different corticosteroid doses. Despite the findings, corticosteroids play an important role in treating patients with severe pneumonia from COVID-19, given the severe inflammatory process observed in these patients.