Corticosteroids with or without antiviral therapy in elderly patients hospitalized with COVID-19 during the Omicron era: A multicenter real-world study

IF 2.8 4区医学 Q2 IMMUNOLOGY

Journal of Virus Eradication Pub Date : 2026-06-01 Epub Date: 2026-05-30 DOI:10.1016/j.jve.2026.100626

Shenglin Xu , Zhaohui Huang , Xuejing Zou , Guiping Li , Richeng Mao , Li Liu , Yue Guo , Xiaoyong Zhang

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引用次数: 0

Abstract

Background

Elderly patients remain at high risk for adverse outcomes from COVID-19 despite the generally reduced pathogenicity of the Omicron variant. Corticosteroids are commonly used in hospitalized patients with COVID-19, particularly in those with more severe disease, while antiviral agents inhibit viral replication. However, evidence comparing corticosteroid monotherapy with corticosteroid–antiviral combination therapy in elderly hospitalized patients remains limited.

Methods

This multicenter retrospective cohort study included hospitalized patients aged ≥60 years with laboratory-confirmed COVID-19 at two tertiary hospitals in China, all of whom received systemic corticosteroid therapy during hospitalization. Patients were classified into either a corticosteroid monotherapy group or corticosteroid–antiviral combination therapy group. To reduce confounding, inverse probability of treatment weighting (IPTW) based on propensity scores was applied. The primary outcome was all-cause in-hospital mortality, and mechanical ventilation was assessed as a secondary outcome.

Results

A total of 624 elderly hospitalized patients with COVID-19 who received systemic corticosteroid therapy were included in the IPTW analysis (290 in the corticosteroid group and 334 in the combination therapy group). After weighting, baseline characteristics were well balanced between groups. The weighted incidence of in-hospital mortality was lower in the combination therapy group than in the corticosteroid monotherapy group (8.09% vs 13.47%; OR 0.566, 95% CI 0.333–0.961; p = 0.035). No statistically significant difference was observed in the risk of mechanical ventilation between groups (OR 1.286, 95% CI 0.924–1.789; p = 0.136).

Conclusions

Among elderly hospitalized patients with COVID-19 during the Omicron period who received systemic corticosteroid therapy corticosteroids combined with antiviral therapy were associated with lower in-hospital mortality compared with corticosteroid monotherapy, while no significant difference was observed in mechanical ventilation.

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一项多中心现实世界研究：在欧米克隆时代，老年COVID-19住院患者接受或不接受抗病毒治疗的皮质类固醇

背景：尽管欧米克隆变异的致病性普遍降低，但老年患者发生COVID-19不良后果的风险仍然很高。皮质类固醇通常用于COVID-19住院患者，特别是病情较严重的患者，而抗病毒药物则抑制病毒复制。然而，在老年住院患者中比较皮质类固醇单一治疗与皮质类固醇-抗病毒联合治疗的证据仍然有限。方法本多中心回顾性队列研究纳入中国两家三级医院收治的年龄≥60岁的实验室确诊COVID-19住院患者，所有患者住院期间均接受全身皮质类固醇治疗。患者分为皮质类固醇单药治疗组和皮质类固醇-抗病毒联合治疗组。为了减少混淆，应用基于倾向得分的治疗加权逆概率（IPTW）。主要结局为全因住院死亡率，机械通气作为次要结局进行评估。结果624例接受全身糖皮质激素治疗的住院老年COVID-19患者纳入IPTW分析，其中糖皮质激素组290例，联合治疗组334例。加权后，各组之间的基线特征平衡良好。联合治疗组住院死亡率加权发生率低于皮质类固醇单药治疗组（8.09% vs 13.47%; OR 0.566, 95% CI 0.333-0.961; p = 0.035）。机械通气风险组间比较差异无统计学意义（OR 1.286, 95% CI 0.924-1.789; p = 0.136）。结论在Omicron期间接受全身皮质类固醇治疗的老年住院COVID-19患者中，皮质类固醇联合抗病毒治疗与皮质类固醇单一治疗相比，住院死亡率较低，而机械通气无显著差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Virus Eradication Medicine-Public Health, Environmental and Occupational Health

CiteScore

6.10

自引率

1.80%

发文量

审稿时长

39 weeks

期刊介绍： The Journal of Virus Eradication aims to provide a specialist, open-access forum to publish work in the rapidly developing field of virus eradication. The Journal covers all human viruses, in the context of new therapeutic strategies, as well as societal eradication of viral infections with preventive interventions. The Journal is aimed at the international community involved in the prevention and management of viral infections. It provides an academic forum for the publication of original research into viral reservoirs, viral persistence and virus eradication and ultimately development of cures. The Journal not only publishes original research, but provides an opportunity for opinions, reviews, case studies and comments on the published literature. It focusses on evidence-based medicine as the major thrust in the successful management of viral infections.The Journal encompasses virological, immunological, epidemiological, modelling, pharmacological, pre-clinical and in vitro, as well as clinical, data including but not limited to drugs, immunotherapy and gene therapy. It is an important source of information on the development of vaccine programs and preventative measures aimed at virus eradication.