Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients : a multicentre cohort study
Moreno, Gerard (Universitat Autònoma de Barcelona. Departament de Medicina)
Carbonell, Raquel (Universitat Autònoma de Barcelona. Departament de Medicina)
Martin-Loeches, Ignacio (St. James's Hospital ( Dublín, Irlanda))
Solé-Violán, Jordi (Hospital Universitari de Gran Canària Doctor Negrín)
Correig i Fraga, Eudald (Universitat Rovira i Virgili)
Gómez, Josep (Universitat Autònoma de Barcelona. Departament de Medicina)
Ruiz-Botella, Manuel (Universitat Autònoma de Barcelona. Departament de Medicina)
Trefler, Sandra (Hospital Universitari Joan XXIII de Tarragona)
Bodí, María (Hospital Universitari Joan XXIII de Tarragona)
Murcia Paya, Josefa (Hospital General Universitario Santa Lucía (Cartagena, Múrcia))
Díaz Santos, Emilio (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Vidal-Cortes, Pablo (Complexo Hospitalario Universitario de Ourense - CHUO)
Papiol, Elisabeth (Hospital Universitari Vall d'Hebron)
Albaya-Moreno, Antonio (Universidad de Alcalá)
Sancho Chinesta, Susana (Hospital Universitari i Politècnic La Fe de Valencia)
Socias Crespi, Lorenzo (Hospital Son Llàtzer)
Lorente, María del Carmen (Hospital Rafael Méndez)
Loza Vázquez, Ana (Hospital Universitario Nuestra Señora de Valme)
Vara Arlanzon, Rebeca (Hospital Universitario de Burgos)
Recio, María Teresa (Hospital Universitario de Salamanca)
Ballesteros, Juan Carlos (Hospital Universitario de Salamanca)
Ferrer, Ricard (Hospital Universitari Vall d'Hebron)
Fernandez Rey, Elisabeth (Hospital Central Universitario de Asturias)
Restrepo, Marcos I. (South Texas Veterans Health Care System and University of Texas Health)
Estella, Ángel (Hospital Universitario de Jerez (Jerez de la Frontera))
Margarit Ribas, Antonio (Hospital Nostra Senyora de Meritxell)
Guasch, Neus (Hospital Nostra Senyora de Meritxell)
Reyes, Luis F. (Universidad de La Sabana)
Marin-Corral, Judith (Institut Hospital del Mar d'Investigacions Mèdiques)
Rodríguez, Alejandro (Universitat Rovira i Virgili)

Date:	2021
Abstract:	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. 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. 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. 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. The online version contains supplementary material available at 10. 1186/s13613-021-00951-0.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Corticosteroids ; COVID-19-associated acute respiratory distress syndrome ; Intensive care unit ; Invasive mechanical ventilation ; Mortality
Published in:	Annals of Intensive Care, Vol. 11 (november 2021) , ISSN 2110-5820

DOI: 10.1186/s13613-021-00951-0
PMID: 34825976

15 p, 1.8 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Parc Taulí Research and Innovation Institute (I3PT
Articles > Research articles
Articles > Published articles