A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients
© 2021 Elsevier España, S.L.U. y SEMICYUC. All rights reserved..
Objective: To determine if the use of corticosteroids was associated with Intensive Care Unit (ICU) mortality among whole population and pre-specified clinical phenotypes.
Design: A secondary analysis derived from multicenter, observational study.
Setting: Critical Care Units.
Patients: Adult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain.
Interventions: Corticosteroids vs. no corticosteroids.
Main variables of interest: Three phenotypes were derived by non-supervised clustering analysis from whole population and classified as (A: severe, B: critical and C: life-threatening). We performed a multivariate analysis after propensity optimal full matching (PS) for whole population and weighted Cox regression (HR) and Fine-Gray analysis (sHR) to assess the impact of corticosteroids on ICU mortality according to the whole population and distinctive patient clinical phenotypes.
Results: A total of 2017 patients were analyzed, 1171 (58%) with corticosteroids. After PS, corticosteroids were shown not to be associated with ICU mortality (OR: 1.0; 95% CI: 0.98-1.15). Corticosteroids were administered in 298/537 (55.5%) patients of "A" phenotype and their use was not associated with ICU mortality (HR = 0.85 [0.55-1.33]). A total of 338/623 (54.2%) patients in "B" phenotype received corticosteroids. No effect of corticosteroids on ICU mortality was observed when HR was performed (0.72 [0.49-1.05]). Finally, 535/857 (62.4%) patients in "C" phenotype received corticosteroids. In this phenotype HR (0.75 [0.58-0.98]) and sHR (0.79 [0.63-0.98]) suggest a protective effect of corticosteroids on ICU mortality.
Conclusion: Our finding warns against the widespread use of corticosteroids in all critically ill patients with COVID-19 at moderate dose. Only patients with the highest inflammatory levels could benefit from steroid treatment.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:47 |
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| Enthalten in: |
Medicina intensiva - 47(2023), 1 vom: 15. Jan., Seite 23-33 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Moreno, G [VerfasserIn] |
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| Links: |
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| Themen: |
COVID-19 |
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| Anmerkungen: |
Date Revised 11.01.2023 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.medin.2021.10.002 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM332585573 |
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| 100 | 1 | |a Moreno, G |e verfasserin |4 aut | |
| 245 | 1 | 2 | |a A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Revised 11.01.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2021 Elsevier España, S.L.U. y SEMICYUC. All rights reserved. | ||
| 520 | |a Objective: To determine if the use of corticosteroids was associated with Intensive Care Unit (ICU) mortality among whole population and pre-specified clinical phenotypes | ||
| 520 | |a Design: A secondary analysis derived from multicenter, observational study | ||
| 520 | |a Setting: Critical Care Units | ||
| 520 | |a Patients: Adult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain | ||
| 520 | |a Interventions: Corticosteroids vs. no corticosteroids | ||
| 520 | |a Main variables of interest: Three phenotypes were derived by non-supervised clustering analysis from whole population and classified as (A: severe, B: critical and C: life-threatening). We performed a multivariate analysis after propensity optimal full matching (PS) for whole population and weighted Cox regression (HR) and Fine-Gray analysis (sHR) to assess the impact of corticosteroids on ICU mortality according to the whole population and distinctive patient clinical phenotypes | ||
| 520 | |a Results: A total of 2017 patients were analyzed, 1171 (58%) with corticosteroids. After PS, corticosteroids were shown not to be associated with ICU mortality (OR: 1.0; 95% CI: 0.98-1.15). Corticosteroids were administered in 298/537 (55.5%) patients of "A" phenotype and their use was not associated with ICU mortality (HR = 0.85 [0.55-1.33]). A total of 338/623 (54.2%) patients in "B" phenotype received corticosteroids. No effect of corticosteroids on ICU mortality was observed when HR was performed (0.72 [0.49-1.05]). Finally, 535/857 (62.4%) patients in "C" phenotype received corticosteroids. In this phenotype HR (0.75 [0.58-0.98]) and sHR (0.79 [0.63-0.98]) suggest a protective effect of corticosteroids on ICU mortality | ||
| 520 | |a Conclusion: Our finding warns against the widespread use of corticosteroids in all critically ill patients with COVID-19 at moderate dose. Only patients with the highest inflammatory levels could benefit from steroid treatment | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Corticosteroids | |
| 650 | 4 | |a ICU mortality | |
| 650 | 4 | |a Phenotypes | |
| 650 | 4 | |a SARS-CoV2-pneumonia | |
| 650 | 4 | |a Unsupervised clustering | |
| 700 | 1 | |a Ruiz-Botella, M |e verfasserin |4 aut | |
| 700 | 1 | |a Martín-Loeches, I |e verfasserin |4 aut | |
| 700 | 1 | |a Gómez Álvarez, J |e verfasserin |4 aut | |
| 700 | 1 | |a Jiménez Herrera, M |e verfasserin |4 aut | |
| 700 | 1 | |a Bodí, M |e verfasserin |4 aut | |
| 700 | 1 | |a Armestar, F |e verfasserin |4 aut | |
| 700 | 1 | |a Marques Parra, A |e verfasserin |4 aut | |
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| 700 | 1 | |a Trefler, S |e verfasserin |4 aut | |
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| 700 | 1 | |a Albaya-Moreno, A |e verfasserin |4 aut | |
| 700 | 1 | |a Socias-Crespi, L |e verfasserin |4 aut | |
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| 700 | 1 | |a Sancho Chinesta, S |e verfasserin |4 aut | |
| 700 | 1 | |a Loza, A |e verfasserin |4 aut | |
| 700 | 1 | |a Forcelledo Espina, L |e verfasserin |4 aut | |
| 700 | 1 | |a Pozo Laderas, J C |e verfasserin |4 aut | |
| 700 | 1 | |a deAlba-Aparicio, M |e verfasserin |4 aut | |
| 700 | 1 | |a Sánchez Montori, L |e verfasserin |4 aut | |
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| 700 | 1 | |a Hidalgo, V |e verfasserin |4 aut | |
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| 700 | 1 | |a Casamitjana Ortega, A M |e verfasserin |4 aut | |
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