1. Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study
- Author
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Gerard Moreno, Raquel Carbonell, Ignacio Martin-Loeches, Jordi Solé-Violán, Eudald Correig i Fraga, Josep Gómez, Manuel Ruiz-Botella, Sandra Trefler, María Bodí, Josefa Murcia Paya, Emili Díaz, Pablo Vidal-Cortes, Elisabeth Papiol, Antonio Albaya Moreno, Susana Sancho Chinesta, Lorenzo Socias Crespi, María del Carmen Lorente, Ana Loza Vázquez, Rebeca Vara Arlanzon, María Teresa Recio, Juan Carlos Ballesteros, Ricard Ferrer, Elisabeth Fernandez Rey, Marcos I. Restrepo, Ángel Estella, Antonio Margarit Ribas, Neus Guasch, Luis F. Reyes, Judith Marín-Corral, Alejandro Rodríguez, the COVID-19 SEMICYUC Working Group, Institut Català de la Salut, [Moreno G, Carbonell R] Universitat Autònoma de Barcelona, Bellaterra, Spain. Critical Care Department, Joan XXIII University Hospital, 43005 Tarragona, Spain. [Martin-Loeches I] Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s Hospital, Dublin, Ireland. [Solé-Violán J] Critical Care Department, Doctor Negrín University Hospital, Gran Canaria, Spain. [Correig i Fraga E] Department of Biostatistics, University of Rovira i Virgili (URV), Reus, Spain. [Gómez J] Universitat Autònoma de Barcelona, Bellaterra, Spain. Critical Care Department, Joan XXIII University Hospital, 43005 Tarragona, Spain. Tarragona Health Data Research Working Group (THeDaR), Joan XXIII University Hospital, Tarragona, Spain. [Papiol E] Unitat de Cures Intensives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Ferrer R] Unitat de Cures Intensives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca en Xoc, Disfunció Orgànica i Ressuscitació, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
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ARDS ,medicine.medical_specialty ,COVID-19 (Malaltia) - Mortalitat ,terapéutica::terapéutica::tratamiento de urgencia::resucitación::terapéutica::respiración artificial [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Critical Care and Intensive Care Medicine ,Otros calificadores::Otros calificadores::/efectos adversos [Otros calificadores] ,Respiració artificial - Complicacions ,law.invention ,chemistry.chemical_compound ,Tocilizumab ,law ,Therapeutics::Therapeutics::Emergency Treatment::Resuscitation::Therapeutics::Respiration, Artificial [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,Anesthesiology ,Internal medicine ,Other subheadings::Other subheadings::Other subheadings::/mortality [Other subheadings] ,medicine ,Other subheadings::Other subheadings::/adverse effects [Other subheadings] ,virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES] ,Corticosteroids ,Intensive care unit ,Mortality ,Invasive mechanical ventilation ,COVID-19-associated acute respiratory distress syndrome ,Survival analysis ,Otros calificadores::Otros calificadores::Otros calificadores::/mortalidad [Otros calificadores] ,business.industry ,RC86-88.9 ,Research ,Retrospective cohort study ,Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES] ,Medical emergencies. Critical care. Intensive care. First aid ,medicine.disease ,chemistry ,Propensity score matching ,business ,Cohort study - Abstract
COVID-19-associated acute respiratory distress syndrome; Corticosteroids; Intensive care unit Síndrome de dificultad respiratoria aguda asociado a COVID-19; Corticosteroides; Unidad de cuidados intensivos Síndrome de dificultat respiratòria aguda associada a la COVID-19; Corticosteroides; Unitat de cures intensives 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
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- 2021