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: eudald.correig@urv.cat josep.gomez@urv.cat alejandrohugo.rodriguez@urv.cat mariaamparo.bodi@urv.cat mariaamparo.bodi@urv.cat eudald.correig@urv.cat
Author identifier: 0000-0002-0573-7621 0000-0001-8828-5984 0000-0001-7652-8379 0000-0001-7652-8379
Record's date: 2023-10-28
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: http://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
Repositori URV