Autor según el artículo: 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
Departamento: Bioquímica i Biotecnologia; Ciències Mèdiques Bàsiques
Autor/es de la URV: Bodi Saera, Maria Amparo / Correig Fraga, Eudald / Gómez Alvarez, Josep / Rodríguez Oviedo, Alejandro Hugo
Palabras clave: 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
Resumen: 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.
Áreas temáticas: Saúde coletiva; Medicina iii; Medicina ii; Medicina i; Engenharias iv; Critical care medicine; Critical care and intensive care medicine; Ciências biológicas ii
Acceso a la licencia de uso: https://creativecommons.org/licenses/by/3.0/es/
Direcció de correo del autor: josep.gomez@urv.cat; eudald.correig@urv.cat; eudald.correig@urv.cat; alejandrohugo.rodriguez@urv.cat; mariaamparo.bodi@urv.cat; mariaamparo.bodi@urv.cat
Fecha de alta del registro: 2025-02-18
Versión del articulo depositado: info:eu-repo/semantics/publishedVersion
Enlace a la fuente original: https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-021-00951-0
URL Documento de licencia: https://repositori.urv.cat/ca/proteccio-de-dades/
Referencia al articulo segun fuente origial: Annals Of Intensive Care. 11 (1): 159-
Referencia de l'ítem segons les normes 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), 159-. DOI: 10.1186/s13613-021-00951-0
DOI del artículo: 10.1186/s13613-021-00951-0
Entidad: Universitat Rovira i Virgili
Año de publicación de la revista: 2021
Tipo de publicación: Journal Publications
Repositori URV