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1. A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients

Author

María Blasco Cortes, María Jiménez Herrera, Manuel Ruiz-Botella, Emili Diaz, Josep Gómez Alvarez, Josep Maria Bonell Goytisolo, Fernando Arméstar, Angel Estella, Susana Sancho Chinesta, Ignacio Martin-Loeches, Juan Carlos Pozo Laderas, Ruth Jorge García, Sandra Trefler, G. Moreno, Fátima Martín Serrano, María Bodí, Mercedes Nieto, Ricard Ferrer, Lorenzo Socias-Crespi, Ana Loza, Alejandro Rodriguez, Judith Marin-Corral, Antonio Albaya-Moreno, Jordi Solé-Violán, Laura Sánchez Montori, Pablo Vidal Cortés, Asunción Marques Parra, Ana Mª Casamitjana Ortega, Virginia Fraile Gutiérrez, Josefa Murcia Paya, Virginia Hidalgo, Lorena Forcelledo Espina, María deAlba-Aparicio, and Immaculada Vallverdú Perapoch

Subjects
medicine.medical_specialty, Multivariate analysis, Coronavirus disease 2019 (COVID-19), Population, Disease, SARS-CoV2-pneumonia, Critical Care and Intensive Care Medicine, Fenotipos clínicos, Article, law.invention, law, Internal medicine, Medicine, Corticosteroids, education, Mortalidad en UCI, ComputingMethodologies_COMPUTERGRAPHICS, ICU Mortality, education.field_of_study, business.industry, Proportional hazards model, COVID-19, neumonía por SARS-CoV-2, Phenotype, Intensive care unit, Corticoides, Phenotypes, Agrupamiento no supervisado, Observational study, Unsupervised clustering, business
Abstract

Graphical abstract Fx1, Objetivo: Evaluar si el uso de corticoesteroides (Cs) se asocia con la mortalidad en la unidad de cuidados intensivos (UCI) en la población global y dentro de los fenotipos clínicos predeterminados Diseño: Análisis secundario de estudio multicéntrico observacional Ámbito: UCI Pacientes: Pacientes adultos con COVID-19 confirmado ingresados en 63 UCIs de España Intervención: Corticoides vs. no Corticoides Variables de interés principales: A partir del análisis no supervisado de grupos, 3 fenotipos clínicos fueron derivados y clasificados como: A: grave, B: critico and C: potencialmente mortal. Se efectuó un análisis multivariado después de un propensity optimal full matching (PS) y una regresión ponderada de Cox (HR) y análisis de Fine-Gray (sHR) para evaluar el impacto del tratamiento con Cs sobre la mortalidad en la población general y en cada fenotipo clínico. Resultados: Un total de 2.017 pacientes fueron analizados, 1.171(58%) con Cs. Después del PS, el uso de Cs no se relacionó significativamente con la mortalidad en UCI (OR:1.0,95%CI:0.98-1.15). Cs fueron administrados en 298/537(55.5%) pacientes del fenotipo “A” y no se observó asociación significativa con la mortalidad (HR=0.85[0.55-1.33]). Un total de 338/623(54.2%) pacientes del fenotipo “B” recibieron Cs sin efecto significativo sobre la mortalidad (HR=0.72[0.49-1.05]). Finalmente, 535/857(62.4%) pacientes del fenotipo “C” recibieron Cs. En este fenotipo, se evidenció un efecto protector de los Cs sobre la mortalidad HR (0.75[0.58-0.98]). Conclusión: Nuestros hallazgos alertan sobre el uso indiscriminado de Cs a dosis moderadas en todos los pacientes críticos con COVID-19. Solamente pacientes con elevado estado de inflamación podrían beneficiarse con el tratamiento con Cs.

Published
2023

2. A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients.

Author

Moreno G, Ruiz-Botella M, Martín-Loeches I, Gómez Álvarez J, Jiménez Herrera M, Bodí M, Armestar F, Marques Parra A, Estella Á, Trefler S, Jorge García R, Murcia Paya J, Vidal Cortes P, Díaz E, Ferrer R, Albaya-Moreno A, Socias-Crespi L, Bonell Goytisolo JM, Sancho Chinesta S, Loza A, Forcelledo Espina L, Pozo Laderas JC, deAlba-Aparicio M, Sánchez Montori L, Vallverdú Perapoch I, Hidalgo V, Fraile Gutiérrez V, Casamitjana Ortega AM, Martín Serrano F, Nieto M, Blasco Cortes M, Marín-Corral J, Solé-Violán J, and Rodríguez A

Abstract

Objective: To determine if the use of corticosteroids was associated with Intensive Care Unit (ICU) mortality among whole population and pre-specified clinical phenotypes., Design: A secondary analysis derived from multicenter, observational study., Setting: Critical Care Units., Patients: Adult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain., Interventions: Corticosteroids vs. no corticosteroids., Main Variables of Interest: Three phenotypes were derived by non-supervised clustering analysis from whole population and classified as (A: severe, B: critical and C: life-threatening). We performed a multivariate analysis after propensity optimal full matching (PS) for whole population and weighted Cox regression (HR) and Fine-Gray analysis (sHR) to assess the impact of corticosteroids on ICU mortality according to the whole population and distinctive patient clinical phenotypes., Results: A total of 2017 patients were analyzed, 1171 (58%) with corticosteroids. After PS, corticosteroids were shown not to be associated with ICU mortality (OR: 1.0; 95% CI: 0.98-1.15). Corticosteroids were administered in 298/537 (55.5%) patients of "A" phenotype and their use was not associated with ICU mortality (HR = 0.85 [0.55-1.33]). A total of 338/623 (54.2%) patients in "B" phenotype received corticosteroids. No effect of corticosteroids on ICU mortality was observed when HR was performed (0.72 [0.49-1.05]). Finally, 535/857 (62.4%) patients in "C" phenotype received corticosteroids. In this phenotype HR (0.75 [0.58-0.98]) and sHR (0.79 [0.63-0.98]) suggest a protective effect of corticosteroids on ICU mortality., Conclusion: Our finding warns against the widespread use of corticosteroids in all critically ill patients with COVID-19 at moderate dose. Only patients with the highest inflammatory levels could benefit from steroid treatment., (© 2021 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)

Published
2023
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