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Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study - imarina:9241173

Autor/s de la URV:Bodi Saera, Maria Amparo / Correig Fraga, Eudald / Gómez Alvarez, Josep / Rodríguez Oviedo, Alejandro Hugo
Autor segons l'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
Adreça de correu electrònic de l'autor:josep.gomez@urv.cat
eudald.correig@urv.cat
alejandrohugo.rodriguez@urv.cat
eudald.correig@urv.cat
mariaamparo.bodi@urv.cat
mariaamparo.bodi@urv.cat
Identificador de l'autor:0000-0002-0573-7621
0000-0001-8828-5984
0000-0001-7652-8379
0000-0001-7652-8379
Any de publicació de la revista:2021
Tipus de publicació:Journal Publications
Referència 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), -. DOI: 10.1186/s13613-021-00951-0
Referència a l'article segons font original:Annals Of Intensive Care. 11 (1):
Resum: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.
DOI de l'article:10.1186/s13613-021-00951-0
Enllaç font original:https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-021-00951-0
Versió de l'article dipositat:info:eu-repo/semantics/publishedVersion
Accès a la llicència d'ús:https://creativecommons.org/licenses/by/3.0/es/
Departament:Bioquímica i Biotecnologia
Ciències Mèdiques Bàsiques
URL Document de llicència:https://repositori.urv.cat/ca/proteccio-de-dades/
Àrees temàtiques:Saúde coletiva
Medicina iii
Medicina ii
Medicina i
Engenharias iv
Critical care medicine
Critical care and intensive care medicine
Ciências biológicas ii
Paraules clau: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
Entitat:Universitat Rovira i Virgili
Data d'alta del registre:2024-07-27
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