Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19 : CIBERESUCICOVID study
© 2022. Springer-Verlag GmbH Germany, part of Springer Nature..
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.
| Errataetall: |
CommentIn: Intensive Care Med. 2022 Jul;48(7):926-929. - PMID 35732834 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:48 |
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| Enthalten in: |
Intensive care medicine - 48(2022), 7 vom: 21. Juli, Seite 850-864 |
| Sprache: |
Englisch |
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| Links: |
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| Themen: |
Adrenal Cortex Hormones |
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| Anmerkungen: |
Date Completed 13.07.2022 Date Revised 16.12.2022 published: Print-Electronic CommentIn: Intensive Care Med. 2022 Jul;48(7):926-929. - PMID 35732834 Citation Status MEDLINE |
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| doi: |
10.1007/s00134-022-06726-w |
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NLM342485644 |
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| 245 | 1 | 0 | |a Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19 |b CIBERESUCICOVID study |
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| 500 | |a Date Revised 16.12.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Intensive Care Med. 2022 Jul;48(7):926-929. - PMID 35732834 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022. Springer-Verlag GmbH Germany, part of Springer Nature. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Corticosteroids | |
| 650 | 4 | |a Critically ill | |
| 650 | 4 | |a Intensive care | |
| 650 | 7 | |a Adrenal Cortex Hormones |2 NLM | |
| 650 | 7 | |a Steroids |2 NLM | |
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| 700 | 1 | |a Torres, Mateu |e investigator |4 oth | |
| 700 | 1 | |a Martinez, María |e investigator |4 oth | |
| 700 | 1 | |a Alegre, Cynthia |e investigator |4 oth | |
| 700 | 1 | |a Contreras, Sofía |e investigator |4 oth | |
| 700 | 1 | |a Trujillano, Javier |e investigator |4 oth | |
| 700 | 1 | |a Vallverdú, Montse |e investigator |4 oth | |
| 700 | 1 | |a León, Miguel |e investigator |4 oth | |
| 700 | 1 | |a Badía, Mariona |e investigator |4 oth | |
| 700 | 1 | |a Balsera, Begoña |e investigator |4 oth | |
| 700 | 1 | |a Servià, Lluís |e investigator |4 oth | |
| 700 | 1 | |a Vilanova, Judit |e investigator |4 oth | |
| 700 | 1 | |a Rodríguez, Silvia |e investigator |4 oth | |
| 700 | 1 | |a Montserrat, Neus |e investigator |4 oth | |
| 700 | 1 | |a Iglesias, Silvia |e investigator |4 oth | |
| 700 | 1 | |a Prados, Javier |e investigator |4 oth | |
| 700 | 1 | |a Carvalho, Sula |e investigator |4 oth | |
| 700 | 1 | |a Miralbés, Mar |e investigator |4 oth | |
| 700 | 1 | |a Monclou, Josman |e investigator |4 oth | |
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| 700 | 1 | |a Sanchez-Giron, Gloria Renedo |e investigator |4 oth | |
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