Articles producció científica> Ciències Mèdiques Bàsiques

Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study

  • Identification data

    Identifier: imarina:9241173
    Authors:
    Moreno, GerardCarbonell, RaquelMartin-Loeches, IgnacioSole-Violan, JordiFraga, Eudald Correig, IGomez, JosepRuiz-Botella, ManuelTrefler, SandraBodi, MariaPaya, Josefa MurciaDiaz, EmiliVidal-Cortes, PabloPapiol, ElisabethAlbaya Moreno, AntonioSancho Chinesta, SusanaSocias Crespi, LorenzoDel Carmen Lorente, MariaLoza Vazquez, AnaVara Arlanzon, RebecaTeresa Recio, MariaCarlos Ballesteros, JuanFerrer, RicardFernandez Rey, ElisabethRestrepo, Marcos, IEstella, AngelMargarit Ribas, AntonioGuasch, NeusReyes, Luis F.Marin-Corral, JudithRodriguez, AlejandroCOVID-19 SEMICYUC Working Grp
    Abstract:
    Background Some unanswered questions persist regarding the effectiveness of corticosteroids for severe coronavirus disease 2019 (COVID-19) patients. We aimed to assess the clinical effect of corticosteroids on intensive care unit (ICU) mortality among mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients. Methods This was a retrospective study of prospectively collected data conducted in 70 ICUs (68 Spanish, one Andorran, one Irish), including mechanically ventilated COVID-19-associated ARDS patients admitted between February 6 and September 20, 2020. Individuals who received corticosteroids for refractory shock were excluded. Patients exposed to corticosteroids at admission were matched with patients without corticosteroids through propensity score matching. Primary outcome was all-cause ICU mortality. Secondary outcomes were to compare in-hospital mortality, ventilator-free days at 28 days, respiratory superinfection and length of stay between patients with corticosteroids and those without corticosteroids. We performed survival analysis accounting for competing risks and subgroup sensitivity analysis. Results We included 1835 mechanically ventilated COVID-19-associated ARDS, of whom 1117 (60.9%) received corticosteroids. After propensity score matching, ICU mortality did not differ between patients treated with corticosteroids and untreated patients (33.8% vs. 30.9%; p = 0.28). In survival analysis, corticosteroid treatment at ICU admission was associated with short-term survival benefit (HR 0.53; 95% CI 0.39-0.72), although beyond the 17th day of admission, this effect switched and there was an increased ICU mortality (long-term HR 1.68; 95% CI 1.16-2.45). The sensitivity analysis reinforced the results. Subgroups of age < 6
  • Others:

    Author, as appears in the article.: Moreno, Gerard; Carbonell, Raquel; Martin-Loeches, Ignacio; Sole-Violan, Jordi; Fraga, Eudald Correig, I; Gomez, Josep; Ruiz-Botella, Manuel; Trefler, Sandra; Bodi, Maria; Paya, Josefa Murcia; Diaz, Emili; Vidal-Cortes, Pablo; Papiol, Elisabeth; Albaya Moreno, Antonio; Sancho Chinesta, Susana; Socias Crespi, Lorenzo; Del Carmen Lorente, Maria; Loza Vazquez, Ana; Vara Arlanzon, Rebeca; Teresa Recio, Maria; Carlos Ballesteros, Juan; Ferrer, Ricard; Fernandez Rey, Elisabeth; Restrepo, Marcos, I; Estella, Angel; Margarit Ribas, Antonio; Guasch, Neus; Reyes, Luis F.; Marin-Corral, Judith; Rodriguez, Alejandro;COVID-19 SEMICYUC Working Grp
    Department: Bioquímica i Biotecnologia Ciències Mèdiques Bàsiques
    URV's Author/s: Bodi Saera, Maria Amparo / Correig Fraga, Eudald / Gómez Alvarez, Josep / Rodríguez Oviedo, Alejandro Hugo
    Keywords: Ventilator associated pneumonia Ventilated patient Treatment duration Tocilizumab Survival analysis Superinfection Short term survival Shock Sensitivity analysis Reverse transcription polymerase chain reaction Retrospective study Propensity score Procalcitonin Positive end expiratory pressure ventilation Pandemic Oxygen therapy Outcome assessment Noninvasive ventilation Multicenter study Mortality risk Mortality Methylprednisolone Medical record Male Major clinical study Lopinavir plus ritonavir Length of stay Laboratory test Invasive ventilation Invasive mechanical ventilation Intubation Interferon Intensive care unit In-hospital mortality Hypertension Human Hospital discharge High flow nasal cannula therapy Fraction of inspired oxygen Follow up Female Dexamethasone Demography D dimer Critically-ill patients Covid-19-associated acute respiratory distress syndrome Covid-19 Corticosteroids Corticosteroid therapy Corticosteroid Coronavirus disease 2019 Controlled study Comorbidity Cohort analysis C reactive protein Article Apache Aged Adult respiratory distress syndrome Adult Adjuvant therapy Acute kidney failure
    Abstract: Background Some unanswered questions persist regarding the effectiveness of corticosteroids for severe coronavirus disease 2019 (COVID-19) patients. We aimed to assess the clinical effect of corticosteroids on intensive care unit (ICU) mortality among mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients. Methods This was a retrospective study of prospectively collected data conducted in 70 ICUs (68 Spanish, one Andorran, one Irish), including mechanically ventilated COVID-19-associated ARDS patients admitted between February 6 and September 20, 2020. Individuals who received corticosteroids for refractory shock were excluded. Patients exposed to corticosteroids at admission were matched with patients without corticosteroids through propensity score matching. Primary outcome was all-cause ICU mortality. Secondary outcomes were to compare in-hospital mortality, ventilator-free days at 28 days, respiratory superinfection and length of stay between patients with corticosteroids and those without corticosteroids. We performed survival analysis accounting for competing risks and subgroup sensitivity analysis. Results We included 1835 mechanically ventilated COVID-19-associated ARDS, of whom 1117 (60.9%) received corticosteroids. After propensity score matching, ICU mortality did not differ between patients treated with corticosteroids and untreated patients (33.8% vs. 30.9%; p = 0.28). In survival analysis, corticosteroid treatment at ICU admission was associated with short-term survival benefit (HR 0.53; 95% CI 0.39-0.72), although beyond the 17th day of admission, this effect switched and there was an increased ICU mortality (long-term HR 1.68; 95% CI 1.16-2.45). The sensitivity analysis reinforced the results. Subgroups of age < 60 years, severe ARDS and corticosteroids plus tocilizumab could have greatest benefit from corticosteroids as short-term decreased ICU mortality without long-term negative effects were observed. Larger length of stay was observed with corticosteroids among non-survivors both in the ICU and in hospital. There were no significant differences for the remaining secondary outcomes. Conclusions Our results suggest that corticosteroid treatment for mechanically ventilated COVID-19-associated ARDS had a biphasic time-dependent effect on ICU mortality. Specific subgroups showed clear effect on improving survival with corticosteroid use. Therefore, further research is required to identify treatment-responsive subgroups among the mechanically ventilated COVID-19-associated ARDS patients.
    Thematic Areas: Saúde coletiva Medicina iii Medicina ii Medicina i Engenharias iv Critical care medicine Critical care and intensive care medicine Ciências biológicas ii
    licence for use: https://creativecommons.org/licenses/by/3.0/es/
    Author's mail: josep.gomez@urv.cat eudald.correig@urv.cat alejandrohugo.rodriguez@urv.cat eudald.correig@urv.cat mariaamparo.bodi@urv.cat mariaamparo.bodi@urv.cat
    Author identifier: 0000-0002-0573-7621 0000-0001-8828-5984 0000-0001-7652-8379 0000-0001-7652-8379
    Record's date: 2024-07-27
    Papper version: info:eu-repo/semantics/publishedVersion
    Link to the original source: https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-021-00951-0
    Licence document URL: https://repositori.urv.cat/ca/proteccio-de-dades/
    Papper original source: Annals Of Intensive Care. 11 (1):
    APA: Moreno, Gerard; Carbonell, Raquel; Martin-Loeches, Ignacio; Sole-Violan, Jordi; Fraga, Eudald Correig, I; Gomez, Josep; Ruiz-Botella, Manuel; Trefler, (2021). Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study. Annals Of Intensive Care, 11(1), -. DOI: 10.1186/s13613-021-00951-0
    Article's DOI: 10.1186/s13613-021-00951-0
    Entity: Universitat Rovira i Virgili
    Journal publication year: 2021
    Publication Type: Journal Publications
  • Keywords:

    Critical Care and Intensive Care Medicine,Critical Care Medicine
    Ventilator associated pneumonia
    Ventilated patient
    Treatment duration
    Tocilizumab
    Survival analysis
    Superinfection
    Short term survival
    Shock
    Sensitivity analysis
    Reverse transcription polymerase chain reaction
    Retrospective study
    Propensity score
    Procalcitonin
    Positive end expiratory pressure ventilation
    Pandemic
    Oxygen therapy
    Outcome assessment
    Noninvasive ventilation
    Multicenter study
    Mortality risk
    Mortality
    Methylprednisolone
    Medical record
    Male
    Major clinical study
    Lopinavir plus ritonavir
    Length of stay
    Laboratory test
    Invasive ventilation
    Invasive mechanical ventilation
    Intubation
    Interferon
    Intensive care unit
    In-hospital mortality
    Hypertension
    Human
    Hospital discharge
    High flow nasal cannula therapy
    Fraction of inspired oxygen
    Follow up
    Female
    Dexamethasone
    Demography
    D dimer
    Critically-ill patients
    Covid-19-associated acute respiratory distress syndrome
    Covid-19
    Corticosteroids
    Corticosteroid therapy
    Corticosteroid
    Coronavirus disease 2019
    Controlled study
    Comorbidity
    Cohort analysis
    C reactive protein
    Article
    Apache
    Aged
    Adult respiratory distress syndrome
    Adult
    Adjuvant therapy
    Acute kidney failure
    Saúde coletiva
    Medicina iii
    Medicina ii
    Medicina i
    Engenharias iv
    Critical care medicine
    Critical care and intensive care medicine
    Ciências biológicas ii
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