Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study
Abstract 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-associ...
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oai:doaj.org-article:53187fa3b02845bb914364437b77d9682021-11-28T12:03:37ZCorticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study10.1186/s13613-021-00951-02110-5820https://doaj.org/article/53187fa3b02845bb914364437b77d9682021-11-01T00:00:00Zhttps://doi.org/10.1186/s13613-021-00951-0https://doaj.org/toc/2110-5820Abstract 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 < 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. Conclusions 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.Gerard MorenoRaquel CarbonellIgnacio Martin-LoechesJordi Solé-ViolánEudald Correig i FragaJosep GómezManuel Ruiz-BotellaSandra TreflerMaría BodíJosefa Murcia PayaEmili DíazPablo Vidal-CortesElisabeth PapiolAntonio Albaya MorenoSusana Sancho ChinestaLorenzo Socias CrespiMaría del Carmen LorenteAna Loza VázquezRebeca Vara ArlanzonMaría Teresa RecioJuan Carlos BallesterosRicard FerrerElisabeth Fernandez ReyMarcos I. RestrepoÁngel EstellaAntonio Margarit RibasNeus GuaschLuis F. ReyesJudith Marín-CorralAlejandro Rodríguezthe COVID-19 SEMICYUC Working GroupSpringerOpenarticleCorticosteroidsCOVID-19-associated acute respiratory distress syndromeIntensive care unitMortalityInvasive mechanical ventilationMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENAnnals of Intensive Care, Vol 11, Iss 1, Pp 1-15 (2021) |
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DOAJ |
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EN |
| topic |
Corticosteroids COVID-19-associated acute respiratory distress syndrome Intensive care unit Mortality Invasive mechanical ventilation Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 |
| spellingShingle |
Corticosteroids COVID-19-associated acute respiratory distress syndrome Intensive care unit Mortality Invasive mechanical ventilation Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 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 Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study |
| description |
Abstract 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 < 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. Conclusions 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. |
| format |
article |
| author |
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 |
| author_facet |
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 |
| author_sort |
Gerard Moreno |
| title |
Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study |
| title_short |
Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study |
| title_full |
Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study |
| title_fullStr |
Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study |
| title_full_unstemmed |
Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study |
| title_sort |
corticosteroid treatment and mortality in mechanically ventilated covid-19-associated acute respiratory distress syndrome (ards) patients: a multicentre cohort study |
| publisher |
SpringerOpen |
| publishDate |
2021 |
| url |
https://doaj.org/article/53187fa3b02845bb914364437b77d968 |
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