Association of acute-phase corticosteroid use with SARS-CoV-2 reinfection among hospitalized COVID-19 survivors:a 3-year follow-up study

Background While corticosteroids are standard treatment for severe COVID-19, their potential impact on the long-term risk of SARS-CoV-2 reinfection remains unclear. This study assessed whether corticosteroid use during acute infection increases 3-year reinfection risk. Methods This study included adults COVID-19 survivors discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan and May 2020 and completed the 3-year follow-up. Analyses were grouped by corticosteroid use (use vs non-use), and further by treatment duration (<7, 7-10, >10 days), cumulative dose (≤560 mg vs >560 mg methylprednisolone equivalents) and initiation timing. The primary outcome was reinfection risk; severity of reinfection and other clinical outcomes were designated as secondary outcomes. Results Among 913 participants (median age 61.0 years, 53.8% male), 677 (74.1%) received supplemental oxygen during hospitalization. The reinfection proportion (70.4% [157/223] vs 70.0% [483/690], p=0.976) was comparable between corticosteroid and non-corticosteroid group. Reinfection severity, evaluated by the pneumonia incidence and oxygen requirement, also did not differ significantly. Further analyses revealed neither treatment duration, cumulative dose, nor initiation timing was significantly associated with reinfection risk or severity. These findings remained consistent across vaccinated and unvaccinated subgroups. Conclusions Our findings provided evidence that corticosteroids during acute COVID-19 was not associated with an increased susceptibility to SARS-CoV-2 reinfection.