tetano
Editor, Senior Moderator
Crit Care
. 2021 Jan 4;25(1):2.
doi: 10.1186/s13054-020-03422-3.
Early corticosteroids are associated with lower mortality in critically ill patients with COVID-19: a cohort study
Pablo Monedero[SUP] 1 [/SUP], Alfredo Gea[SUP] 2 [/SUP], Pedro Castro[SUP] 3 [/SUP], Angel M Candela-Toha[SUP] 4 [/SUP], Mar?a L Hern?ndez-Sanz[SUP] 5 [/SUP], Egoitz Arruti[SUP] 6 [/SUP], Jes?s Villar[SUP] 7 8 9 [/SUP], Carlos Ferrando[SUP] 7 10 [/SUP], COVID-19 Spanish ICU Network
Collaborators, Affiliations
Abstract
Background: Critically ill patients with coronavirus disease 19 (COVID-19) have a high fatality rate likely due to a dysregulated immune response. Corticosteroids could attenuate this inappropriate response, although there are still some concerns regarding its use, timing, and dose.
Methods: This is a nationwide, prospective, multicenter, observational, cohort study in critically ill adult patients with COVID-19 admitted into Intensive Care Units (ICU) in Spain from 12th March to 29th June 2020. Using a multivariable Cox model with inverse probability weighting, we compared relevant outcomes between patients treated with early corticosteroids (before or within the first 48 h of ICU admission) with those who did not receive early corticosteroids (delayed group) or any corticosteroids at all (never group). Primary endpoint was ICU mortality. Secondary endpoints included 7-day mortality, ventilator-free days, and complications.
Results: A total of 691 patients out of 882 (78.3%) received corticosteroid during their hospital stay. Patients treated with early-corticosteroids (n = 485) had lower ICU mortality (30.3% vs. never 36.6% and delayed 44.2%) and lower 7-day mortality (7.2% vs. never 15.2%) compared to non-early treated patients. They also had higher number of ventilator-free days, less length of ICU stay, and less secondary infections than delayed treated patients. There were no differences in medical complications between groups. Of note, early use of moderate-to-high doses was associated with better outcomes than low dose regimens.
Conclusion: Early use of corticosteroids in critically ill patients with COVID-19 is associated with lower mortality than no or delayed use, and fewer complications than delayed use.
Keywords: COVID-19; Cohort study; Corticosteroids; Critically ill patient; Intensive Care Unit; Mortality; Outcomes; Ventilator-free days.
. 2021 Jan 4;25(1):2.
doi: 10.1186/s13054-020-03422-3.
Early corticosteroids are associated with lower mortality in critically ill patients with COVID-19: a cohort study
Pablo Monedero[SUP] 1 [/SUP], Alfredo Gea[SUP] 2 [/SUP], Pedro Castro[SUP] 3 [/SUP], Angel M Candela-Toha[SUP] 4 [/SUP], Mar?a L Hern?ndez-Sanz[SUP] 5 [/SUP], Egoitz Arruti[SUP] 6 [/SUP], Jes?s Villar[SUP] 7 8 9 [/SUP], Carlos Ferrando[SUP] 7 10 [/SUP], COVID-19 Spanish ICU Network
Collaborators, Affiliations
- PMID: 33397463
- DOI: 10.1186/s13054-020-03422-3
Abstract
Background: Critically ill patients with coronavirus disease 19 (COVID-19) have a high fatality rate likely due to a dysregulated immune response. Corticosteroids could attenuate this inappropriate response, although there are still some concerns regarding its use, timing, and dose.
Methods: This is a nationwide, prospective, multicenter, observational, cohort study in critically ill adult patients with COVID-19 admitted into Intensive Care Units (ICU) in Spain from 12th March to 29th June 2020. Using a multivariable Cox model with inverse probability weighting, we compared relevant outcomes between patients treated with early corticosteroids (before or within the first 48 h of ICU admission) with those who did not receive early corticosteroids (delayed group) or any corticosteroids at all (never group). Primary endpoint was ICU mortality. Secondary endpoints included 7-day mortality, ventilator-free days, and complications.
Results: A total of 691 patients out of 882 (78.3%) received corticosteroid during their hospital stay. Patients treated with early-corticosteroids (n = 485) had lower ICU mortality (30.3% vs. never 36.6% and delayed 44.2%) and lower 7-day mortality (7.2% vs. never 15.2%) compared to non-early treated patients. They also had higher number of ventilator-free days, less length of ICU stay, and less secondary infections than delayed treated patients. There were no differences in medical complications between groups. Of note, early use of moderate-to-high doses was associated with better outcomes than low dose regimens.
Conclusion: Early use of corticosteroids in critically ill patients with COVID-19 is associated with lower mortality than no or delayed use, and fewer complications than delayed use.
Keywords: COVID-19; Cohort study; Corticosteroids; Critically ill patient; Intensive Care Unit; Mortality; Outcomes; Ventilator-free days.