A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients [Una consideración terapéutica diferencial para el uso de corticoesteroides en COVID-19 según los diferentes fenotipos clínicos establecidos en pacientes críticos]

Identificador:  imarina:9242304

Handle: https://hdl.handle.net/20.500.11797/imarina9242304

Autores:  Moreno, G; Ruiz-Botella, M; Martín-Loeches,; Alvarez, JG; Herrera, MJ; Bodí, M; Armestar, F; Parra, AM; Estella, A; Trefler, S; García, RJ; Paya, JM; Cortes, PV; Díaz, E; Ferrer, R; Albaya-Moreno, A; Socias-Crespi, L; Goytisolo, JMB; Chinesta, SS; Loza, A; Espina, LF; Laderas, JCP; DeAlba-Aparicio, M; Montori, LS; Perapoch, IV; Hidalgo,; Gutiérrez, VF; Ortega, AMC; Serrano, FM; Nieto, M; Cortes, MB; Marín-Corral, J; Solé-Violán, J; Rodríguez, A

Resumen:
Objective: To determine if the use of corticosteroids was associated with Intensive Care Unit (ICU) mortality among whole population and pre-specified clinical phenotypes. Design: A secondary analysis derived from multicenter, observational study. Setting: Critical Care Units. Patients: Adult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain. Interventions: Corticosteroids vs. no corticosteroids. Main variables of interest: Three phenotypes were derived by non-supervised clustering analysis from whole population and classified as (A: severe, B: critical and C: life-threatening). We performed a multivariate analysis after propensity optimal full matching (PS) for whole population and weighted Cox regression (HR) and Fine-Gray analysis (sHR) to assess the impact of corticosteroids on ICU mortality according to the whole population and distinctive patient clinical phenotypes. Results: A total of 2017 patients were analyzed, 1171 (58%) with corticosteroids. After PS, corticosteroids were shown not to be associated with ICU mortality (OR: 1.0; 95% CI: 0.98–1.15). Corticosteroids were administered in 298/537 (55.5%) patients of “A” phenotype and their use was not associated with ICU mortality (HR = 0.85 [0.55–1.33]). A total of 338/623 (54.2%) patients in “B” phenotype received corticosteroids. No effect of corticosteroids on ICU mortality was observed when HR was performed (0.72 [0.49–1.05]). Finally, 535/857 (62.4%) patients in “C” phenotype received corticosteroids. In this phenotype HR (0.75 [0.58–0.98]) and sHR (0.79 [0.63–0.98]) suggest a protective effect of corticosteroids on ICU mortality. Conclusion: Our finding warns against the widespread use of corticosteroids in all critically ill patients with COVID-19 at moderate dose. Only patients with the highest inflammatory levels could benefit from steroid treatment. © 2021 Elsevier España, S.L.U. y SEMICYUC