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Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study

2022; Springer Science+Business Media; Volume: 48; Issue: 7 Linguagem: Inglês

10.1007/s00134-022-06726-w

1432-1238

Antoní Torres, Ana Motos, Catia Cillóniz, Adrián Ceccato, Laia Fernández‐Barat, Albert Gabarrús, Jesús F. Bermejo-Martín, Ricard Ferrer, Jordi Riera, Raquel Pérez-Arnal, Dario García-Gasulla, Óscar Peñuelas, José Ángel Lorente, David de Gonzalo‐Calvo, Raquel Almansa, Rosario Menéndez, Andrea Palomeque, Rosario Amaya Villar, José M. Añón, Ana Balan Mariño, Carme Barberà, José Barberán, Aaron Blandino Ortíz, María Victoria Boado, Elena Bustamante‐Munguira, Jesús Caballero, María Luisa Cantón‐Bulnes, Cristina Carbajales Pérez, Nieves Carbonell, Mercedes Catalán-González, Raúl de Frutos, Nieves Franco, Cristobal Galbán‐Malagón, Víctor D. Gumucio-Sanguino, María del Carmen de la Torre, Emili Dı́az, Ángel Estella, Elena Gallego, J.L. García Garmendia, José M. Gómez, Arturo Huerta, Ruth Noemí Jorge García, Ana Loza-Vázquez, Judith Marín‐Corral, M.C. Martín Delgado, Amalia Martínez de la Gándara, Ignacio Martínez Varela, Juan López Messa, Guillermo M. Albaiceta, Maite Nieto, Mariana Andrea Novo, Yhivian Peñasco, Felipe Pérez‐García, Juan Carlos Pozo Laderas, Pilar Ricart, Víctor Sagredo-Meneses, Ángel Sánchez-Miralles, Susana Sancho Chinesta, Mireia Serra-Fortuny, Lorenzo Socías, Jordi Solé‐Violán, Fernando Suárez-Sipmann, Luis Tamayo Lomas, Josep Trenado, Alejandro Úbeda, Luis Jorge Valdivia, Pablo Vidal, Ferrán Barbé, Rafael Máñez, Felipe Rodrı́guez de Castro, María Mora Aznar, Mateu Torres, María Martínez-Martínez, Cynthia Alegre, Sofía Contreras, Javier Trujillano, Montse Vallverdú, Miguel Leonardo García León, Mariona Badía, Begoña Balsera, Luis Serviá, Judit Vilanova, Silvia Rodríguez, Neus Montserrat, Sílvia Iglesias, Javier Prados, Sula Carvalho, Mar Miralbés, Josman Monclou, Gabriel Jiménez, Jordi Codina, Estela Val, Pablo Pagliarani, Jorge Rubio, Dulce Morales, Andrés Pujol, Àngels Furro, Beatriz García, Gerard Torres, Javier Vengoechea, David de Gozalo Calvo, Jessica González, Sílvia Gómez, Lorena Forcelledo Espina, Emilio García Prieto, Paula Martín Vicente, Cecilia del Busto Martínez, María Aguilar Cabello, Carmen Eulalia Martínez Fernández, María Luisa Blasco, Ainhoa Serrano, Mar Juan Díaz, María Teresa Bouza Vieiro, Inés Esmorís Arijón, David Campi Hermoso, Rafaela Nogueras Salinas, Teresa Farre Monjo, Ramón Nogué Bou, Gregorio Marco Naya, Núria Ramon Coll, Juan Carlos Montejo, Gloria Renedo Sánchez‐Girón, Juan Bustamante‐Munguira, Ramón Cicuéndez Avila, Nuria Mamolar Herrera, Alexander Agrifoglio, Lucía Cachafeiro, Emilio Maseda, Albert Figueras, Maria Teresa Janer, Laura Soliva, Marta Ocón, Luisa Clar, Ignacio Ayestarán, Sandra Campos Fernández, Eva Forcadell-Ferreres, Immaculada Salvador-Adell, Neus Bofill, Berta Adell-Serrano, Josep Pedregosa Díaz, Núria Casacuberta-Barberà, Luis Urrelo-Cerrón, Àngels Piñol-Tena, Ferran Roche‐Campo, Pablo Ryan, Covadonga Rodríguez Ruíz, Laura Carrión García, Juan I. Lazo Álvarez, Desire Macias Guerrero, Daniel Tognetti, Carlos García Redruello, David Mosquera Rodríguez, Eva María Menor Fernández, Sabela Vara Adrio, Vanesa Gómez Casal, Marta Segura Pensado, María Digna Rivas Vilas, Amaia García Sagastume, Raúl de Pablo, David Pestaña Laguna, Tommaso Bardi, Carmen Gómez González, Maria Luisa Gascón Castillo, José Garnacho‐Montero, Joan Ramón Masclans, Ana Salazar Degracia, Judit Bigas, Rosana Muñoz-Bermúdez, C. Vilà, F. Gómez, Irene Dot, Ana Zapatero, Yolanda Díaz, M.P. Gracia, Purificación Pérez, Andrea Castellví, Cristina Climent, Lidia Serra, Laura Barbena, Iosune Cano, Alba Herraiz, Pilar Marcos, Laura Rodríguez, María Teresa Sariñena, Ana Sánchez, J.F. Masa Jiménez, Gemma Gomà, Mercedes Ibarz, Diego de Mendoza, Enric Barbeta, Victoria Alcaraz-Serrano, Joan R. Badia, Manuel Castellá, Leticia Bueno, Laia Fernández‐Barat, Catia Cillóniz, Pamela Conde, Javier Fernández, Albert Gabarrús, Karsa Kiarostami, Alexandre López-Gavín, Cecilia L. Mantellini, Carla Speziale, Nil Vázquez, Hua Yang, Minlan Yang, Carlos Ferrando, Pedro Castro, Marta Arrieta, José M. Nicolás, Rut Andrea, Marta Barroso, Sergio Álvarez, Dario García-Gasulla, Adrián Tormos, César Aldecoa, Rubén Herrán‐Monge, José Ángel Berezo García, Pedro Enríquez Giraudo, Pablo Cardinal Fernández, Alberto Rubio-López, Orville Báez Pravia, Leire Pérez Bastida, Antonjo Álvarez Ruiz, Anna Pous, Ana López Lago, Eva Saborido Paz, Patricia Barral Segade, Manuel Valledor Mendez, Luciano Aguilera, Esther López-Ramos, Ángela Leonor Ruiz-García, Belén Beteré, Rafael Blancas, Cristina Dólera, Gloria Pérez Planelles, Enrique Marmol Peis, Maria Dolores Martínez Juan, Miriam Ruiz Miralles, Eva Pérez Rubio, Maria Van der Hofstadt Martin-Montalvo, Tatiana Villada Warrington, Sara Guadalupe Moreno Cano, Federico Gordo, Basilisa Martínez Palacios, Maria Teresa Nieto, Sergio Ossa, Ana Ortega, Miguel Sánchez, Bitor Santacoloma,

COVID-19 Clinical Research Studies

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. 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. 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. 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.