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

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• dc.contributor.author Moreno, Gerard
• dc.contributor.author Marin Corral, Judith
• dc.contributor.author Rodríguez, Alejandro
• dc.contributor.author COVID-19 SEMICYUC Working Group
• dc.date.accessioned 2022-06-29T07:06:15Z
• dc.date.issued 2023
• dc.description.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.
• dc.format.mimetype application/pdf
• dc.identifier.citation Moreno G, Ruiz-Botella M, Martín-Loeches I, Alvarez JG, Herrera MJ, Bodí M, et al. A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients. Med Intensiva. 2023 Jan; 47(1): 23-33. DOI: 10.1016/j.medin.2021.10.002
• dc.identifier.doi http://dx.doi.org/10.1016/j.medin.2021.10.002
• dc.identifier.issn 0210-5691
• dc.identifier.uri http://hdl.handle.net/10230/53634
• dc.language.iso eng
• dc.publisher Elsevier
• dc.rights © Elsevier http://dx.doi.org/10.1016/j.medin.2021.10.002
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.subject.keyword COVID-19
• dc.subject.keyword Corticosteroids
• dc.subject.keyword ICU Mortality
• dc.subject.keyword Phenotypes
• dc.subject.keyword SARS-CoV2-pneumonia
• dc.subject.keyword Unsupervised clustering
• dc.title A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/acceptedVersion