Corticosteroid therapy in critically ill patients with COVID-19 : a multicenter, retrospective study
BACKGROUND: Corticoid therapy has been recommended in the treatment of critically ill patients with COVID-19, yet its efficacy is currently still under evaluation. We investigated the effect of corticosteroid treatment on 90-day mortality and SARS-CoV-2 RNA clearance in severe patients with COVID-19.
METHODS: 294 critically ill patients with COVID-19 were recruited between December 30, 2019 and February 19, 2020. Logistic regression, Cox proportional-hazards model and marginal structural modeling (MSM) were applied to evaluate the associations between corticosteroid use and corresponding outcome variables.
RESULTS: Out of the 294 critically ill patients affected by COVID-19, 183 (62.2%) received corticosteroids, with methylprednisolone as the most frequently administered corticosteroid (175 accounting for 96%). Of those treated with corticosteroids, 69.4% received corticosteroid prior to ICU admission. When adjustments and subgroup analysis were not performed, no significant associations between corticosteroids use and 90-day mortality or SARS-CoV-2 RNA clearance were found. However, when stratified analysis based on corticosteroid initiation time was performed, there was a significant correlation between corticosteroid use (≤ 3 day after ICU admission) and 90-day mortality (logistic regression adjusted for baseline: OR 4.49, 95% CI 1.17-17.25, p = 0.025; Cox adjusted for baseline and time varying variables: HR 3.89, 95% CI 1.94-7.82, p < 0.001; MSM adjusted for baseline and time-dependent variants: OR 2.32, 95% CI 1.16-4.65, p = 0.017). No association was found between corticosteroid use and SARS-CoV-2 RNA clearance even after stratification by initiation time of corticosteroids and adjustments for confounding factors (corticosteroids use ≤ 3 days initiation vs no corticosteroids use) using MSM were performed.
CONCLUSIONS: Early initiation of corticosteroid use (≤ 3 days after ICU admission) was associated with an increased 90-day mortality. Early use of methylprednisolone in the ICU is therefore not recommended in patients with severe COVID-19.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
Critical care (London, England) - 24(2020), 1 vom: 18. Dez., Seite 698 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Li, Yiming [VerfasserIn] |
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| Links: |
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| Themen: |
Adrenal Cortex Hormones |
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| Anmerkungen: |
Date Completed 29.12.2020 Date Revised 07.12.2022 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1186/s13054-020-03429-w |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM319044432 |
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| 100 | 1 | |a Li, Yiming |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Corticosteroid therapy in critically ill patients with COVID-19 |b a multicenter, retrospective study |
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| 500 | |a Date Revised 07.12.2022 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Corticoid therapy has been recommended in the treatment of critically ill patients with COVID-19, yet its efficacy is currently still under evaluation. We investigated the effect of corticosteroid treatment on 90-day mortality and SARS-CoV-2 RNA clearance in severe patients with COVID-19 | ||
| 520 | |a METHODS: 294 critically ill patients with COVID-19 were recruited between December 30, 2019 and February 19, 2020. Logistic regression, Cox proportional-hazards model and marginal structural modeling (MSM) were applied to evaluate the associations between corticosteroid use and corresponding outcome variables | ||
| 520 | |a RESULTS: Out of the 294 critically ill patients affected by COVID-19, 183 (62.2%) received corticosteroids, with methylprednisolone as the most frequently administered corticosteroid (175 accounting for 96%). Of those treated with corticosteroids, 69.4% received corticosteroid prior to ICU admission. When adjustments and subgroup analysis were not performed, no significant associations between corticosteroids use and 90-day mortality or SARS-CoV-2 RNA clearance were found. However, when stratified analysis based on corticosteroid initiation time was performed, there was a significant correlation between corticosteroid use (≤ 3 day after ICU admission) and 90-day mortality (logistic regression adjusted for baseline: OR 4.49, 95% CI 1.17-17.25, p = 0.025; Cox adjusted for baseline and time varying variables: HR 3.89, 95% CI 1.94-7.82, p < 0.001; MSM adjusted for baseline and time-dependent variants: OR 2.32, 95% CI 1.16-4.65, p = 0.017). No association was found between corticosteroid use and SARS-CoV-2 RNA clearance even after stratification by initiation time of corticosteroids and adjustments for confounding factors (corticosteroids use ≤ 3 days initiation vs no corticosteroids use) using MSM were performed | ||
| 520 | |a CONCLUSIONS: Early initiation of corticosteroid use (≤ 3 days after ICU admission) was associated with an increased 90-day mortality. Early use of methylprednisolone in the ICU is therefore not recommended in patients with severe COVID-19 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Corticosteroid | |
| 650 | 4 | |a Marginal structural modeling | |
| 650 | 7 | |a Adrenal Cortex Hormones |2 NLM | |
| 650 | 7 | |a Methylprednisolone |2 NLM | |
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| 700 | 1 | |a Meng, Qinghe |e verfasserin |4 aut | |
| 700 | 1 | |a Rao, Xin |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Binbin |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Xingguo |e verfasserin |4 aut | |
| 700 | 1 | |a Dong, Fang |e verfasserin |4 aut | |
| 700 | 1 | |a Yu, Tao |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Zhongyi |e verfasserin |4 aut | |
| 700 | 1 | |a Feng, Huibin |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Jinpeng |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Xiangyang |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Hunian |e verfasserin |4 aut | |
| 700 | 1 | |a Cheng, Yi |e verfasserin |4 aut | |
| 700 | 1 | |a Hong, Xiaoyang |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Xiang |e verfasserin |4 aut | |
| 700 | 1 | |a Yin, Yimei |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Zhongheng |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Dawei |e verfasserin |4 aut | |
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