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

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..

Medienart:

E-Artikel

Erscheinungsjahr:

2022

Erschienen:

2022

Enthalten in:

Zur Gesamtaufnahme - volume:48

Enthalten in:

Intensive care medicine - 48(2022), 7 vom: 21. Juni, Seite 850-864

Sprache:

Englisch

Beteiligte Personen:

Torres, Antoni [VerfasserIn]
Motos, Ana [VerfasserIn]
Cillóniz, Catia [VerfasserIn]
Ceccato, Adrián [VerfasserIn]
Fernández-Barat, Laia [VerfasserIn]
Gabarrús, Albert [VerfasserIn]
Bermejo-Martin, Jesús [VerfasserIn]
Ferrer, Ricard [VerfasserIn]
Riera, Jordi [VerfasserIn]
Pérez-Arnal, Raquel [VerfasserIn]
García-Gasulla, Dario [VerfasserIn]
Peñuelas, Oscar [VerfasserIn]
Lorente, José Ángel [VerfasserIn]
de Gonzalo-Calvo, David [VerfasserIn]
Almansa, Raquel [VerfasserIn]
Menéndez, Rosario [VerfasserIn]
Palomeque, Andrea [VerfasserIn]
Villar, Rosario Amaya [VerfasserIn]
Añón, José M. [VerfasserIn]
Balan Mariño, Ana [VerfasserIn]
Barberà, Carme [VerfasserIn]
Barberán, José [VerfasserIn]
Blandino Ortiz, Aaron [VerfasserIn]
Boado, Maria Victoria [VerfasserIn]
Bustamante-Munguira, Elena [VerfasserIn]
Caballero, Jesús [VerfasserIn]
Cantón-Bulnes, María Luisa [VerfasserIn]
Carbajales Pérez, Cristina [VerfasserIn]
Carbonell, Nieves [VerfasserIn]
Catalán-González, Mercedes [VerfasserIn]
de Frutos, Raul [VerfasserIn]
Franco, Nieves [VerfasserIn]
Galbán, Cristóbal [VerfasserIn]
Gumucio-Sanguino, Víctor D. [VerfasserIn]
de la Torre, Maria del Carmen [VerfasserIn]
Díaz, Emili [VerfasserIn]
Estella, Ángel [VerfasserIn]
Gallego, Elena [VerfasserIn]
García Garmendia, José Luis [VerfasserIn]
Gómez, José M. [VerfasserIn]
Huerta, Arturo [VerfasserIn]
García, Ruth Noemí Jorge [VerfasserIn]
Loza-Vázquez, Ana [VerfasserIn]
Marin-Corral, Judith [VerfasserIn]
Martin Delgado, María Cruz [VerfasserIn]
Martínez de la Gándara, Amalia [VerfasserIn]
Martínez Varela, Ignacio [VerfasserIn]
López Messa, Juan [VerfasserIn]
Albaiceta, Guillermo M. [VerfasserIn]
Nieto, Maite [VerfasserIn]
Novo, Mariana Andrea [VerfasserIn]
Peñasco, Yhivian [VerfasserIn]
Pérez-García, Felipe [VerfasserIn]
Pozo-Laderas, Juan Carlos [VerfasserIn]
Ricart, Pilar [VerfasserIn]
Sagredo, Victor [VerfasserIn]
Sánchez-Miralles, Angel [VerfasserIn]
Sancho Chinesta, Susana [VerfasserIn]
Serra-Fortuny, Mireia [VerfasserIn]
Socias, Lorenzo [VerfasserIn]
Solé-Violan, Jordi [VerfasserIn]
Suarez-Sipmann, Fernando [VerfasserIn]
Tamayo Lomas, Luis [VerfasserIn]
Trenado, José [VerfasserIn]
Úbeda, Alejandro [VerfasserIn]
Valdivia, Luis Jorge [VerfasserIn]
Vidal, Pablo [VerfasserIn]
Barbé, Ferran [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

BKL:

44.69$jIntensivmedizin

Themen:

COVID-19
Corticosteroids
Critically ill
Intensive care

RVK:

RVK Klassifikation

Anmerkungen:

© Springer-Verlag GmbH Germany, part of Springer Nature 2022

doi:

10.1007/s00134-022-06726-w

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC213125055X

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