Early corticosteroids are associated with lower mortality in critically ill patients with COVID-19 : a cohort study
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.
| Errataetall: |
ErratumIn: Crit Care. 2023 Dec 11;27(1):489. - PMID 38082295 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:25 |
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| Enthalten in: |
Critical care (London, England) - 25(2021), 1 vom: 04. Jan., Seite 2 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Monedero, Pablo [VerfasserIn] |
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| Links: |
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| Themen: |
Adrenal Cortex Hormones |
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| Anmerkungen: |
Date Completed 11.01.2021 Date Revised 13.12.2023 published: Electronic ErratumIn: Crit Care. 2023 Dec 11;27(1):489. - PMID 38082295 Citation Status MEDLINE |
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| doi: |
10.1186/s13054-020-03422-3 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM319614050 |
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| 500 | |a ErratumIn: Crit Care. 2023 Dec 11;27(1):489. - PMID 38082295 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Cohort study | |
| 650 | 4 | |a Corticosteroids | |
| 650 | 4 | |a Critically ill patient | |
| 650 | 4 | |a Intensive Care Unit | |
| 650 | 4 | |a Mortality | |
| 650 | 4 | |a Outcomes | |
| 650 | 4 | |a Ventilator-free days | |
| 650 | 7 | |a Adrenal Cortex Hormones |2 NLM | |
| 700 | 1 | |a Gea, Alfredo |e verfasserin |4 aut | |
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| 700 | 1 | |a Ferrando, Carlos |e verfasserin |4 aut | |
| 700 | 0 | |a COVID-19 Spanish ICU Network |e verfasserin |4 aut | |
| 700 | 1 | |a Monedero, Pablo |e investigator |4 oth | |
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