Early corticosteroids are associated with lower mortality in critically ill patients with COVID-19: a cohort study

Medientyp: E-Artikel
Titel: Early corticosteroids are associated with lower mortality in critically ill patients with COVID-19: a cohort study
Beteiligte: Monedero, Pablo; Gea, Alfredo; Castro, Pedro; Candela-Toha, Angel M.; Hernández-Sanz, María L.; Arruti, Egoitz; Villar, Jesús; Ferrando, Carlos; Monedero, Pablo; Gea, Alfredo; Castro, Pedro; Candela-Toha, Angel M.; Vendrell, Marina; Sánchez-Etayo, Gerard; Alcón, Amalia; Belda, Isabel; Agustí, Mercé; Carramiñana, Albert; Gracia, Isabel; Panzeri, Miriam; León, Irene; Balust, Jaume; Navarro, Ricard; Arguís, María José; [...]
Erschienen: Springer Science and Business Media LLC, 2021
Erschienen in: Critical Care
Sprache: Englisch
DOI: 10.1186/s13054-020-03422-3
ISSN: 1364-8535
Schlagwörter: Critical Care and Intensive Care Medicine
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Beschreibung: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Critically ill patients with coronavirus disease 19 (COVID-19) have a high fatality rate likely due to a dysregulated immune response. Corticosteroids could attenuate this inappropriate response, although there are still some concerns regarding its use, timing, and dose.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>This is a nationwide, prospective, multicenter, observational, cohort study in critically ill adult patients with COVID-19 admitted into Intensive Care Units (ICU) in Spain from 12th March to 29th June 2020. Using a multivariable Cox model with inverse probability weighting, we compared relevant outcomes between patients treated with early corticosteroids (before or within the first 48 h of ICU admission) with those who did not receive early corticosteroids (delayed group) or any corticosteroids at all (never group). Primary endpoint was ICU mortality. Secondary endpoints included 7-day mortality, ventilator-free days, and complications.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 691 patients out of 882 (78.3%) received corticosteroid during their hospital stay. Patients treated with early-corticosteroids (n = 485) had lower ICU mortality (30.3% vs. never 36.6% and delayed 44.2%) and lower 7-day mortality (7.2% vs. never 15.2%) compared to non-early treated patients. They also had higher number of ventilator-free days, less length of ICU stay, and less secondary infections than delayed treated patients. There were no differences in medical complications between groups. Of note, early use of moderate-to-high doses was associated with better outcomes than low dose regimens.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Early use of corticosteroids in critically ill patients with COVID-19 is associated with lower mortality than no or delayed use, and fewer complications than delayed use.</jats:p> </jats:sec>
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