tetano
Editor, Senior Moderator
Intensive Care Med
. 2022 Jun 21.
doi: 10.1007/s00134-022-06726-w. Online ahead of print.
Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study
Antoni Torres[SUP] #[/SUP][SUP] 1 2 3 4 [/SUP], Ana Motos[SUP] #[/SUP][SUP] 5 6 7 [/SUP], Catia Cillóniz[SUP] 8 9 10 [/SUP], Adrián Ceccato[SUP] 8 9 10 [/SUP], Laia Fernández-Barat[SUP] 8 9 10 [/SUP], Albert Gabarrús[SUP] 9 10 [/SUP], Jesús Bermejo-Martin[SUP] 8 11 12 [/SUP], Ricard Ferrer[SUP] 13 [/SUP], Jordi Riera[SUP] 13 [/SUP], Raquel Pérez-Arnal[SUP] 14 [/SUP], Dario García-Gasulla[SUP] 14 [/SUP], Oscar Peñuelas[SUP] 8 15 16 [/SUP], José Ángel Lorente[SUP] 8 15 16 [/SUP], David de Gonzalo-Calvo[SUP] 8 17 [/SUP], Raquel Almansa[SUP] 11 [/SUP], Rosario Menéndez[SUP] 18 [/SUP], Andrea Palomeque[SUP] 9 10 [/SUP], Rosario Amaya Villar[SUP] 19 [/SUP], José M Añón[SUP] 8 20 [/SUP], Ana Balan Mariño[SUP] 21 [/SUP], Carme Barberà[SUP] 22 [/SUP], José Barberán[SUP] 23 [/SUP], Aaron Blandino Ortiz[SUP] 24 [/SUP], Maria Victoria Boado[SUP] 25 [/SUP], Elena Bustamante-Munguira[SUP] 26 [/SUP], Jesús Caballero[SUP] 27 [/SUP], María Luisa Cantón-Bulnes[SUP] 28 [/SUP], Cristina Carbajales Pérez[SUP] 29 [/SUP], Nieves Carbonell[SUP] 30 [/SUP], Mercedes Catalán-González[SUP] 31 [/SUP], Raul de Frutos[SUP] 32 [/SUP], Nieves Franco[SUP] 33 [/SUP], Cristóbal Galbán[SUP] 34 [/SUP], Víctor D Gumucio-Sanguino[SUP] 35 36 [/SUP], Maria Del Carmen de la Torre[SUP] 37 [/SUP], Emili Díaz[SUP] 38 39 [/SUP], Ángel Estella[SUP] 40 [/SUP], Elena Gallego[SUP] 41 [/SUP], José Luis García Garmendia[SUP] 42 [/SUP], José M Gómez[SUP] 43 [/SUP], Arturo Huerta[SUP] 44 [/SUP], Ruth Noemí Jorge García[SUP] 45 [/SUP], Ana Loza-Vázquez[SUP] 46 [/SUP], Judith Marin-Corral[SUP] 47 [/SUP], María Cruz Martin Delgado[SUP] 48 [/SUP], Amalia Martínez de la Gándara[SUP] 49 [/SUP], Ignacio Martínez Varela[SUP] 50 [/SUP], Juan López Messa[SUP] 51 [/SUP], Guillermo M Albaiceta[SUP] 8 52 [/SUP], Maite Nieto[SUP] 53 [/SUP], Mariana Andrea Novo[SUP] 54 [/SUP], Yhivian Peñasco[SUP] 55 [/SUP], Felipe Pérez-García[SUP] 56 [/SUP], Juan Carlos Pozo-Laderas[SUP] 57 [/SUP], Pilar Ricart[SUP] 58 [/SUP], Victor Sagredo[SUP] 59 [/SUP], Angel Sánchez-Miralles[SUP] 60 [/SUP], Susana Sancho Chinesta[SUP] 61 [/SUP], Mireia Serra-Fortuny[SUP] 62 [/SUP], Lorenzo Socias[SUP] 63 [/SUP], Jordi Solé-Violan[SUP] 64 [/SUP], Fernando Suarez-Sipmann[SUP] 65 [/SUP], Luis Tamayo Lomas[SUP] 66 [/SUP], José Trenado[SUP] 67 [/SUP], Alejandro Úbeda[SUP] 68 [/SUP], Luis Jorge Valdivia[SUP] 69 [/SUP], Pablo Vidal[SUP] 70 [/SUP], Ferran Barbé[SUP] 8 17 [/SUP], CIBERESUCICOVID Project Investigators
Collaborators, Affiliations
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.
Keywords: COVID-19; Corticosteroids; Critically ill; Intensive care.
. 2022 Jun 21.
doi: 10.1007/s00134-022-06726-w. Online ahead of print.
Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study
Antoni Torres[SUP] #[/SUP][SUP] 1 2 3 4 [/SUP], Ana Motos[SUP] #[/SUP][SUP] 5 6 7 [/SUP], Catia Cillóniz[SUP] 8 9 10 [/SUP], Adrián Ceccato[SUP] 8 9 10 [/SUP], Laia Fernández-Barat[SUP] 8 9 10 [/SUP], Albert Gabarrús[SUP] 9 10 [/SUP], Jesús Bermejo-Martin[SUP] 8 11 12 [/SUP], Ricard Ferrer[SUP] 13 [/SUP], Jordi Riera[SUP] 13 [/SUP], Raquel Pérez-Arnal[SUP] 14 [/SUP], Dario García-Gasulla[SUP] 14 [/SUP], Oscar Peñuelas[SUP] 8 15 16 [/SUP], José Ángel Lorente[SUP] 8 15 16 [/SUP], David de Gonzalo-Calvo[SUP] 8 17 [/SUP], Raquel Almansa[SUP] 11 [/SUP], Rosario Menéndez[SUP] 18 [/SUP], Andrea Palomeque[SUP] 9 10 [/SUP], Rosario Amaya Villar[SUP] 19 [/SUP], José M Añón[SUP] 8 20 [/SUP], Ana Balan Mariño[SUP] 21 [/SUP], Carme Barberà[SUP] 22 [/SUP], José Barberán[SUP] 23 [/SUP], Aaron Blandino Ortiz[SUP] 24 [/SUP], Maria Victoria Boado[SUP] 25 [/SUP], Elena Bustamante-Munguira[SUP] 26 [/SUP], Jesús Caballero[SUP] 27 [/SUP], María Luisa Cantón-Bulnes[SUP] 28 [/SUP], Cristina Carbajales Pérez[SUP] 29 [/SUP], Nieves Carbonell[SUP] 30 [/SUP], Mercedes Catalán-González[SUP] 31 [/SUP], Raul de Frutos[SUP] 32 [/SUP], Nieves Franco[SUP] 33 [/SUP], Cristóbal Galbán[SUP] 34 [/SUP], Víctor D Gumucio-Sanguino[SUP] 35 36 [/SUP], Maria Del Carmen de la Torre[SUP] 37 [/SUP], Emili Díaz[SUP] 38 39 [/SUP], Ángel Estella[SUP] 40 [/SUP], Elena Gallego[SUP] 41 [/SUP], José Luis García Garmendia[SUP] 42 [/SUP], José M Gómez[SUP] 43 [/SUP], Arturo Huerta[SUP] 44 [/SUP], Ruth Noemí Jorge García[SUP] 45 [/SUP], Ana Loza-Vázquez[SUP] 46 [/SUP], Judith Marin-Corral[SUP] 47 [/SUP], María Cruz Martin Delgado[SUP] 48 [/SUP], Amalia Martínez de la Gándara[SUP] 49 [/SUP], Ignacio Martínez Varela[SUP] 50 [/SUP], Juan López Messa[SUP] 51 [/SUP], Guillermo M Albaiceta[SUP] 8 52 [/SUP], Maite Nieto[SUP] 53 [/SUP], Mariana Andrea Novo[SUP] 54 [/SUP], Yhivian Peñasco[SUP] 55 [/SUP], Felipe Pérez-García[SUP] 56 [/SUP], Juan Carlos Pozo-Laderas[SUP] 57 [/SUP], Pilar Ricart[SUP] 58 [/SUP], Victor Sagredo[SUP] 59 [/SUP], Angel Sánchez-Miralles[SUP] 60 [/SUP], Susana Sancho Chinesta[SUP] 61 [/SUP], Mireia Serra-Fortuny[SUP] 62 [/SUP], Lorenzo Socias[SUP] 63 [/SUP], Jordi Solé-Violan[SUP] 64 [/SUP], Fernando Suarez-Sipmann[SUP] 65 [/SUP], Luis Tamayo Lomas[SUP] 66 [/SUP], José Trenado[SUP] 67 [/SUP], Alejandro Úbeda[SUP] 68 [/SUP], Luis Jorge Valdivia[SUP] 69 [/SUP], Pablo Vidal[SUP] 70 [/SUP], Ferran Barbé[SUP] 8 17 [/SUP], CIBERESUCICOVID Project Investigators
Collaborators, Affiliations
- PMID: 35727348
- DOI: 10.1007/s00134-022-06726-w
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.
Keywords: COVID-19; Corticosteroids; Critically ill; Intensive care.