Acute Corticosteroids and Later PASC Risk in Children and Youth

Key Takeaways

• Acute steroid exposure was not associated with a lower overall risk of PASC in this pediatric cohort.
• Among hospitalized patients, a lower risk of gastrointestinal PASC was observed, while other hospitalized outcomes were not significantly different.

In children and youth with acute SARS-CoV-2 infection, corticosteroids given during the acute phase were not associated with a lower overall risk of PASC. Among hospitalized patients, treated children had a lower risk of gastrointestinal PASC, with a hazard ratio of 0.58 and a 95% confidence interval of 0.39 to 0.85.

The investigators used a retrospective cohort design with target-trial emulation in children and youth with SARS-CoV-2 infection. They compared patients who received dexamethasone, prednisone, prednisolone, or methylprednisolone within 12 days of infection with patients who had no steroid exposure. Inverse propensity of treatment weighting balanced covariates within hospitalized and outpatient groups, and PASC was assessed from 1 to 6 months with a computable phenotype definition. Secondary outcomes included respiratory, musculoskeletal, gastrointestinal, and neurological subphenotypes plus the PASC ICD-10-CM code. The starting cohort included 854,128 children and youth, with 768,845 outpatients and 85,283 inpatients at infection, and weighting yielded 22,085 versus 20,373 outpatients and 11,250 versus 10,340 inpatients.

Within the hospitalized group, overall PASC incidence during follow-up did not differ significantly between treated and untreated patients. Gastrointestinal PASC was the only hospitalized outcome with a lower risk after acute steroid exposure. Other hospitalized outcomes, including the overall PASC endpoint, were not significantly different. In the outpatient group, investigators did not observe treatment differences across reported PASC subphenotypes.