학술논문
Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study
Document Type
article
Author
Gerard Moreno; Raquel Carbonell; Ignacio Martin-Loeches; Jordi Solé-Violán; Eudald Correig i Fraga; Josep Gómez; Manuel Ruiz-Botella; Sandra Trefler; María Bodí; Josefa Murcia Paya; Emili Díaz; Pablo Vidal-Cortes; Elisabeth Papiol; Antonio Albaya Moreno; Susana Sancho Chinesta; Lorenzo Socias Crespi; María del Carmen Lorente; Ana Loza Vázquez; Rebeca Vara Arlanzon; María Teresa Recio; Juan Carlos Ballesteros; Ricard Ferrer; Elisabeth Fernandez Rey; Marcos I. Restrepo; Ángel Estella; Antonio Margarit Ribas; Neus Guasch; Luis F. Reyes; Judith Marín-Corral; Alejandro Rodríguez; the COVID-19 SEMICYUC Working Group
Source
Annals of Intensive Care, Vol 11, Iss 1, Pp 1-15 (2021)
Subject
Language
English
ISSN
2110-5820
91436443
91436443
Abstract
Abstract Background Some unanswered questions persist regarding the effectiveness of corticosteroids for severe coronavirus disease 2019 (COVID-19) patients. We aimed to assess the clinical effect of corticosteroids on intensive care unit (ICU) mortality among mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients. Methods This was a retrospective study of prospectively collected data conducted in 70 ICUs (68 Spanish, one Andorran, one Irish), including mechanically ventilated COVID-19-associated ARDS patients admitted between February 6 and September 20, 2020. Individuals who received corticosteroids for refractory shock were excluded. Patients exposed to corticosteroids at admission were matched with patients without corticosteroids through propensity score matching. Primary outcome was all-cause ICU mortality. Secondary outcomes were to compare in-hospital mortality, ventilator-free days at 28 days, respiratory superinfection and length of stay between patients with corticosteroids and those without corticosteroids. We performed survival analysis accounting for competing risks and subgroup sensitivity analysis. Results We included 1835 mechanically ventilated COVID-19-associated ARDS, of whom 1117 (60.9%) received corticosteroids. After propensity score matching, ICU mortality did not differ between patients treated with corticosteroids and untreated patients (33.8% vs. 30.9%; p = 0.28). In survival analysis, corticosteroid treatment at ICU admission was associated with short-term survival benefit (HR 0.53; 95% CI 0.39–0.72), although beyond the 17th day of admission, this effect switched and there was an increased ICU mortality (long-term HR 1.68; 95% CI 1.16–2.45). The sensitivity analysis reinforced the results. Subgroups of age