학술논문
Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study.
Document Type
Academic Journal
Author
Torres A; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. atorres@clinic.cat.; Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain. atorres@clinic.cat.; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, C/Casanova 143, 08036, Barcelona, Spain. atorres@clinic.cat.; Department of Pulmonary Medicine, Hospital Clinic of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain. atorres@clinic.cat.; Motos A; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. amotos@clinic.cat.; Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain. amotos@clinic.cat.; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, C/Casanova 143, 08036, Barcelona, Spain. amotos@clinic.cat.; Cillóniz C; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain.; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, C/Casanova 143, 08036, Barcelona, Spain.; Ceccato A; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain.; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, C/Casanova 143, 08036, Barcelona, Spain.; Fernández-Barat L; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain.; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, C/Casanova 143, 08036, Barcelona, Spain.; Gabarrús A; Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain.; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, C/Casanova 143, 08036, Barcelona, Spain.; Bermejo-Martin J; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, Salamanca, Spain.; Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain.; Ferrer R; Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain.; Riera J; Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain.; Pérez-Arnal R; Barcelona Supercomputing Centre (BSC), Barcelona, Spain.; García-Gasulla D; Barcelona Supercomputing Centre (BSC), Barcelona, Spain.; Peñuelas O; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Hospital Universitario de Getafe, Madrid, Spain.; Universidad Europea, Madrid, Spain.; Lorente JÁ; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Hospital Universitario de Getafe, Madrid, Spain.; Universidad Europea, Madrid, Spain.; de Gonzalo-Calvo D; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.; Almansa R; Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, Salamanca, Spain.; Menéndez R; Pulmonary Department, University and Polytechnic Hospital La Fe, Valencia, Spain.; Palomeque A; Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain.; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, C/Casanova 143, 08036, Barcelona, Spain.; Villar RA; Intensive Care Clinical Unit, Hospital Universitario Virgen de Rocío, Seville, Spain.; Añón JM; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Medicina Intensiva. Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.; Balan Mariño A; Hospital Universitario San Agustín, Asturias, Spain.; Barberà C; Hospital Santa Maria, IRBLleida, Lleida, Spain.; Barberán J; Hospital Universitario HM Montepríncipe, Universidad San Pablo-CEU, Madrid, Spain.; Blandino Ortiz A; Servicio de Medicina Intensiva, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Boado MV; Hospital Universitario de Cruces, Barakaldo, Spain.; Bustamante-Munguira E; Department of Intensive Care Medicine, Hospital Clínico Universitario Valladolid, Valladolid, Spain.; Caballero J; Critical Care Department, Hospital Universitari Arnau de Vilanova; IRBLleida, Lleida, Spain.; Cantón-Bulnes ML; Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain.; Carbajales Pérez C; Intensive Care Unit, Hospital Álvaro Cunqueiro, Vigo, Spain.; Carbonell N; Intensive Care Unit, Hospital Clínico y Universitario de Valencia, Valencia, Spain.; Catalán-González M; Department of Intensive Care Medicine, Hospital Universitario, 12 de Octubre, Madrid, Spain.; de Frutos R; Servicio de Anestesiología y Reanimación, Hospital Universitario Basurto, Bilbao, Spain.; Franco N; Hospital Universitario de Móstoles, Madrid, Spain.; Galbán C; Department of Medicine, CHUS, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.; Gumucio-Sanguino VD; Department of Intensive Care, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.; de la Torre MDC; Hospital de Mataró de Barcelona, Barcelona, Spain.; Díaz E; Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.; Critical Care Department, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain.; Estella Á; Departamento Medicina Facultad Medicina, Universidad de Cádiz, Hospital Universitario de Jerez, Jerez de la Frontera, Spain.; Gallego E; Unidad de Cuidados Intensivos, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain.; García Garmendia JL; Intensive Care Unit, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville, Spain.; Gómez JM; Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Huerta A; Pulmonary and Critical Care Division, Emergency Department, Clínica Sagrada Família, Barcelona, Spain.; García RNJ; Intensive Care Department, Hospital Nuestra Señora de Gracia, Saragossa, Spain.; Loza-Vázquez A; Unidad de Medicina Intensiva, Hospital Universitario Virgen de Valme, Seville, Spain.; Marin-Corral J; Critical Care Department, Hospital del Mar-IMIM, Barcelona, Spain.; Martin Delgado MC; Hospital Universitario Torrejón-Universidad Francisco de Vitoria, Madrid, Spain.; Martínez de la Gándara A; Department of Intensive Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain.; Martínez Varela I; Critical Care Department, Hospital Universitario Lucus Augusti, Lugo, Spain.; López Messa J; Complejo Asistencial Universitario de Palencia, Palencia, Spain.; Albaiceta GM; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, Hospital Central de Asturias, Oviedo, Spain.; Nieto M; Hospital Universitario de Segovia, Segovia, Spain.; Novo MA; Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain.; Peñasco Y; Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain.; Pérez-García F; Servicio de Microbiología Clínica, Hospital Universitario Príncipe de Asturias-Departamento de Biomedicina y Biotecnología, Universidad de Alcalá de Henares, Madrid, Spain.; Pozo-Laderas JC; UGC-Medicina Intensiva, Hospital Universitario Reina Sofia, Instituto Maimonides IMIBIC, Córdoba, Spain.; Ricart P; Servei de Medicina Intensiva, Hospital Universitari Germans Trias, Badalona, Spain.; Sagredo V; Hospital Universitario de Salamanca, Salamanca, Spain.; Sánchez-Miralles A; Hospital de Sant Joan d'Alacant, Alacant, Spain.; Sancho Chinesta S; Servicio de Medicina Intensiva. Hospital Universitario y Politécnico La Fe, Valencia, Spain.; Serra-Fortuny M; Pneumology Department, Hospital Verge de la Cinta, Tortosa, Tarragona, Spain.; Socias L; Intensive Care Unit, Hospital Son Llàtzer, Palma de Mallorca, Illes Balears, Spain.; Solé-Violan J; Critical Care Department, Hospital Dr. Negrín Gran Canaria, Las Palmas, Gran Canaria, Spain.; Suarez-Sipmann F; Intensive Care Unit, Hospital Universitario La Princesa, Madrid, Spain.; Tamayo Lomas L; Critical Care Department, Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain.; Trenado J; Servicio de Medicina Intensiva, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, Spain.; Úbeda A; Servicio de Medicina Intensiva, Hospital Punta de Europa, Algeciras, Spain.; Valdivia LJ; Hospital Universitario de León, León, Spain.; Vidal P; Complexo Hospitalario Universitario de Ourense, Ourense, Spain.; Barbé F; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.
Source
Publisher: Springer Verlag Country of Publication: United States NLM ID: 7704851 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-1238 (Electronic) Linking ISSN: 03424642 NLM ISO Abbreviation: Intensive Care Med Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose: Although there is evidence supporting the benefits of corticosteroids in patients affected with severe coronavirus disease 2019 (COVID-19), there is little information related to their potential benefits or harm in some subgroups of patients admitted to the intensive care unit (ICU) with COVID-19. We aim to investigate to find candidate variables to guide personalized treatment with steroids in critically ill patients with COVID-19.
Methods: Multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs. The primary outcome was 90-day mortality. Subsequent analyses in clinically relevant subgroups by age, ICU baseline illness severity, organ damage, laboratory findings and mechanical ventilation were performed. High doses of corticosteroids (≥ 12 mg/day equivalent dexamethasone dose), early administration of corticosteroid treatment (< 7 days since symptom onset) and long term of corticosteroids (≥ 10 days) were also investigated.
Results: Between February 2020 and October 2021, 4226 patients were included. Of these, 3592 (85%) patients had received systemic corticosteroids during hospitalisation. In the propensity-adjusted multivariable analysis, the use of corticosteroids was protective for 90-day mortality in the overall population (HR 0.77 [0.65-0.92], p = 0.003) and in-hospital mortality (SHR 0.70 [0.58-0.84], p < 0.001). Significant effect modification was found after adjustment for covariates using propensity score for age (p = 0.001 interaction term), Sequential Organ Failure Assessment (SOFA) score (p = 0.014 interaction term), and mechanical ventilation (p = 0.001 interaction term). We observed a beneficial effect of corticosteroids on 90-day mortality in various patient subgroups, including those patients aged ≥ 60 years; those with higher baseline severity; and those receiving invasive mechanical ventilation at ICU admission. Early administration was associated with a higher risk of 90-day mortality in the overall population (HR 1.32 [1.14-1.53], p < 0.001). Long-term use was associated with a lower risk of 90-day mortality in the overall population (HR 0.71 [0.61-0.82], p < 0.001). No effect was found regarding the dosage of corticosteroids. Moreover, the use of corticosteroids was associated with an increased risk of nosocomial bacterial pneumonia and hyperglycaemia.
Conclusion: Corticosteroid in ICU-admitted patients with COVID-19 may be administered based on age, severity, baseline inflammation, and invasive mechanical ventilation. Early administration since symptom onset may prove harmful.
(© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.)
Methods: Multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs. The primary outcome was 90-day mortality. Subsequent analyses in clinically relevant subgroups by age, ICU baseline illness severity, organ damage, laboratory findings and mechanical ventilation were performed. High doses of corticosteroids (≥ 12 mg/day equivalent dexamethasone dose), early administration of corticosteroid treatment (< 7 days since symptom onset) and long term of corticosteroids (≥ 10 days) were also investigated.
Results: Between February 2020 and October 2021, 4226 patients were included. Of these, 3592 (85%) patients had received systemic corticosteroids during hospitalisation. In the propensity-adjusted multivariable analysis, the use of corticosteroids was protective for 90-day mortality in the overall population (HR 0.77 [0.65-0.92], p = 0.003) and in-hospital mortality (SHR 0.70 [0.58-0.84], p < 0.001). Significant effect modification was found after adjustment for covariates using propensity score for age (p = 0.001 interaction term), Sequential Organ Failure Assessment (SOFA) score (p = 0.014 interaction term), and mechanical ventilation (p = 0.001 interaction term). We observed a beneficial effect of corticosteroids on 90-day mortality in various patient subgroups, including those patients aged ≥ 60 years; those with higher baseline severity; and those receiving invasive mechanical ventilation at ICU admission. Early administration was associated with a higher risk of 90-day mortality in the overall population (HR 1.32 [1.14-1.53], p < 0.001). Long-term use was associated with a lower risk of 90-day mortality in the overall population (HR 0.71 [0.61-0.82], p < 0.001). No effect was found regarding the dosage of corticosteroids. Moreover, the use of corticosteroids was associated with an increased risk of nosocomial bacterial pneumonia and hyperglycaemia.
Conclusion: Corticosteroid in ICU-admitted patients with COVID-19 may be administered based on age, severity, baseline inflammation, and invasive mechanical ventilation. Early administration since symptom onset may prove harmful.
(© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.)