학술논문
Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study
Document Type
Original Paper
Author
Torres, Antoni; Motos, Ana; Cillóniz, Catia; Ceccato, Adrián; Fernández-Barat, Laia; Gabarrús, Albert; Bermejo-Martin, Jesús; Ferrer, Ricard; Riera, Jordi; Pérez-Arnal, Raquel; García-Gasulla, Dario; Peñuelas, Oscar; Lorente, José Ángel; de Gonzalo-Calvo, David; Almansa, Raquel; Menéndez, Rosario; Palomeque, Andrea; Villar, Rosario Amaya; Añón, José M.; Balan Mariño, Ana; Barberà, Carme; Barberán, José; Blandino Ortiz, Aaron; Boado, Maria Victoria; Bustamante-Munguira, Elena; Caballero, Jesús; Cantón-Bulnes, María Luisa; Carbajales Pérez, Cristina; Carbonell, Nieves; Catalán-González, Mercedes; de Frutos, Raul; Franco, Nieves; Galbán, Cristóbal; Gumucio-Sanguino, Víctor D.; de la Torre, Maria del Carmen; Díaz, Emili; Estella, Ángel; Gallego, Elena; García Garmendia, José Luis; Gómez, José M.; Huerta, Arturo; García, Ruth Noemí Jorge; Loza-Vázquez, Ana; Marin-Corral, Judith; Martin Delgado, María Cruz; Martínez de la Gándara, Amalia; Martínez Varela, Ignacio; López Messa, Juan; Albaiceta, Guillermo M.; Nieto, Maite; Novo, Mariana Andrea; Peñasco, Yhivian; Pérez-García, Felipe; Pozo-Laderas, Juan Carlos; Ricart, Pilar; Sagredo, Victor; Sánchez-Miralles, Angel; Sancho Chinesta, Susana; Serra-Fortuny, Mireia; Socias, Lorenzo; Solé-Violan, Jordi; Suarez-Sipmann, Fernando; Tamayo Lomas, Luis; Trenado, José; Úbeda, Alejandro; Valdivia, Luis Jorge; Vidal, Pablo; Barbé, Ferran
Source
Intensive Care Medicine. 48(7):850-864
Subject
Language
English
ISSN
0342-4642
1432-1238
1432-1238
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.