Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study

Fecha de publicación: 01/07/2022 Fecha Ahead of Print: 01/06/2022

Autores de I3PT

Adrián Ceccato

Autor
Ricard Ferrer Roca

Autor
Emilio Diaz Santos

Autor

Participantes ajenos a I3PT

Torres, A
Motos, A
Cilloniz, C
Fernandez-Barat, L
Gabarrus, A
Bermejo-Martin, J
Riera, J
Perez-Arnal, R
Garcia-Gasulla, D
Penuelas, O
Lorente, JA
de Gonzalo-Calvo, D
Almansa, R
Menendez, R
Palomeque, A
Villar, RA
Anon, JM
Marino, AB
Barbera, C
Barberan, J
Ortiz, AB
Boado, MV
Bustamante-Munguira, E
Caballero, J
Canton-Bulnes, ML
Perez, CC
Carbonell, N
Catalan-Gonzalez, M
de Frutos, R
Franco, N
Galban, C
Gumucio-Sanguino, VD
de la Torre, MD
Estella, A
Gallego, E
Garmendia, JLG
Gomez, JM
Huerta, A
Garcia, RNJ
Loza-Vazquez, A
Marin-Corral, J
Delgado, MCM
de la Gandara, AM
Varela, IM
Messa, JL
Albaiceta, GM
Nieto, M
Novo, MA
Penasco, Y
Perez-Garcia, F
Pozo-Laderas, JC
Ricart, P
Sagredo, V
Sanchez-Miralles, A
Chinesta, SS
Serra-Fortuny, M
Socias, L
Sole-Violan, J
Suarez-Sipmann, F
Lomas, LT
Trenado, J
Ubeda, A
Valdivia, LJ
Vidal, P
Barbe, F
CIBERESUCICOVID Project Investigat

Grupos de Investigación

Grup d'estudi de les infeccions comunitàries i relacionades amb l'atenció sanitària

Investigador

Oscar Quijada Pich
Investigació traslacional en el pacient crític

Investigador

Josefina López Aguilar

Abstract

Purpose Although there is evidence supporting the benefits of corticosteroids in patients affected with severe coronavirus disease 2019 (COVID-19), there is little information related to their potential benefits or harm in some subgroups of patients admitted to the intensive care unit (ICU) with COVID-19. We aim to investigate to find candidate variables to guide personalized treatment with steroids in critically ill patients with COVID-19. Methods Multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs. The primary outcome was 90-day mortality. Subsequent analyses in clinically relevant subgroups by age, ICU baseline illness severity, organ damage, laboratory findings and mechanical ventilation were performed. High doses of corticosteroids (>= 12 mg/day equivalent dexamethasone dose), early administration of corticosteroid treatment (< 7 days since symptom onset) and long term of corticosteroids (>= 10 days) were also investigated. Results Between February 2020 and October 2021, 4226 patients were included. Of these, 3592 (85%) patients had received systemic corticosteroids during hospitalisation. In the propensity-adjusted multivariable analysis, the use of corticosteroids was protective for 90-day mortality in the overall population (HR 0.77 [0.65-0.92], p = 0.003) and in-hospital mortality (SHR 0.70 [0.58-0.84], p < 0.001). Significant effect modification was found after adjustment for covariates using propensity score for age (p = 0.001 interaction term), Sequential Organ Failure Assessment (SOFA) score (p = 0.014 interaction term), and mechanical ventilation (p = 0.001 interaction term). We observed a beneficial effect of corticosteroids on 90-day mortality in various patient subgroups, including those patients aged >= 60 years; those with higher baseline severity; and those receiving invasive mechanical ventilation at ICU admission. Early administration was associated with a higher risk of 90-day mortality in the overall population (HR 1.32 [1.14-1.53], p < 0.001). Long-term use was associated with a lower risk of 90-day mortality in the overall population (HR 0.71 [0.61-0.82], p < 0.001). No effect was found regarding the dosage of corticosteroids. Moreover, the use of corticosteroids was associated with an increased risk of nosocomial bacterial pneumonia and hyperglycaemia. Conclusion Corticosteroid in ICU-admitted patients with COVID-19 may be administered based on age, severity, baseline inflammation, and invasive mechanical ventilation. Early administration since symptom onset may prove harmful.