To determine whether the use of
steroids within 2 days of admission for non-MIS-C
COVID-19 in children is associated with hospital
length of stay (LOS). The secondary objective was to determine their association with intensive care unit (ICU) LOS,
inflammation, and
fever defervescence.
Design, Setting, and Participants: This cohort study analyzed data retrospectively for children (<18 years) who required hospitalization for non-MIS-C
COVID-19. Data from March 2020 through September 2021 were provided by 58 hospitals in 7 countries who participate in the Society of
Critical Care Medicine Discovery
Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry.
Exposure: A total of 1163 patients met inclusion criteria and had a median (IQR) age of 7 years (0.9-14.3). Almost half of all patients (601/1163, 51.7%) were male, 33.8% (392/1163) were non-Hispanic White, and 27.9% (324/1163) were Hispanic. Of the study population, 184 patients (15.8%) received
steroids within 2 days of admission, and 979 (84.2%) did not receive
steroids within the first 2 days. Among 1163 patients, 658 (56.5%) required respiratory support during hospitalization. Overall, patients in the
steroids group were older and had greater severity of illness, and a larger proportion required respiratory and vasoactive support. On multivariable linear regression, after controlling for treatment with
remdesivir within 2 days, country, race and ethnicity,
obesity and comorbidity, number of abnormal inflammatory mediators, age, bacterial or viral
coinfection, and disease severity according to ICU admission within first 2 days or World Health Organization ordinal scale of 4 or higher on admission, with a random intercept for the site, early
steroid treatment was not significantly associated with hospital LOS (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Separate analyses for patients with an LOS of 2 days or longer (n = 729), those receiving respiratory support at admission (n = 286), and propensity score-matched patients also showed no significant association between
steroids and LOS. Early
steroid treatment was not associated with ICU LOS,
fever defervescence by day 3, or normalization of inflammatory mediators.
Conclusions and Relevance: