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

on behalf of the CIBERESUCICOVID Project Investigators

Producción científica: Artículo CientíficoArtículo originalrevisión exhaustiva

15 Citas (Scopus)

Resumen

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.

Idioma originalInglés estadounidense
Páginas (desde-hasta)850-864
-15
PublicaciónIntensive Care Medicine
Volumen48
N.º7
DOI
EstadoIndizado - jul. 2022
Publicado de forma externa

Nota bibliográfica

Funding Information:
We are indebted to all participating medical and nursing colleagues for their assistance and cooperation in this study. Thank you to Anthony Armenta for providing language editing assistance for this article. CIBERESUCICOVID Project Investigators: Rafael Mañez: Hospital Universitario de Bellvitge, Barcelona. Felipe Rodríguez de Castro: Hospital Dr. Negrín, Las Palmas. María Mora Aznar: Hospital Nuestra Señora de Gracia, Zaragoza. Mateu Torres, María Martinez, Cynthia Alegre, Sofía Contreras: Hospital Universitari Vall d’Hebron, Barcelona. Javier Trujillano, Montse Vallverdú, Miguel León, Mariona Badía, Begoña Balsera, Lluís Servià, Judit Vilanova, Silvia Rodríguez, Neus Montserrat, Silvia Iglesias, Javier Prados, Sula Carvalho, Mar Miralbés, Josman Monclou, Gabriel Jiménez, Jordi Codina, Estela Val, Pablo Pagliarani, Jorge Rubio, Dulce Morales, Andrés Pujol, Àngels Furro, Beatriz García, Gerard Torres, Javier Vengoechea, David de Gozalo Calvo, Jessica González, Silvia Gomez: Hospital Universitari Arnau de Vilanova, Lleida. Lorena Forcelledo Espina, Emilio García Prieto, Paula Martín Vicente, Cecilia del Busto Martínez: Hospital Universitario Central de Asturias, Oviedo. María Aguilar Cabello, Carmen Eulalia Martínez Fernández: Hospital San Juan de Dios del Aljarafe, Sevilla. María Luisa Blasco Cortés, Ainhoa Serrano Lázaro, Mar Juan Díaz: Hospital Clínic Universitari de València, Valencia. María Teresa Bouza Vieiro, Inés Esmorís Arijón: Hospital Universitario Lucus Augusti, Lugo. David Campi Hermoso., Rafaela Nogueras Salinas., Teresa Farre Monjo., Ramon Nogue Bou., Gregorio Marco Naya., Núria Ramon Coll: Hospital Universitari de Santa Maria, Lleida. Juan Carlos Montejo-González: Hospital Universitario 12 de Octubre, Madrid. Gloria Renedo Sanchez-Giron, Juan Bustamante-Munguira, Ramon Cicuendez Avila, Nuria Mamolar Herrera: Hospital Clínico Universitario, Valladolid. Alexander Agrifoglio, Lucia Cachafeiro, Emilio Maseda: Hospital Universitario La Paz-Carlos III, Madrid. Albert Figueras, Maria Teresa Janer, Laura Soliva, Marta Ocón, Luisa Clar, J Ignacio Ayestarán: Hospital Universitario Son Espases, Palma de Mallorca. Sandra Campos Fernández: Hospital Universitario Marqués de Valdecilla, Santander. Eva Forcadell-Ferreres, Immaculada Salvador-Adell, Neus Bofill, Berta Adell-Serrano, Josep Pedregosa Díaz, Núria Casacuberta-Barberà, Luis Urrelo-Cerrón, Àngels Piñol-Tena, Ferran Roche-Campo: Hospital Verge de la Cinta de Tortosa, Tortosa. Pablo Ryan Murúa, Covadonga Rodríguez Ruíz, Laura Carrión García, Juan I Lazo Álvarez: Hospital Universitario Infanta Leonor, Madrid. Desire Macias Guerrero: Hospital Universitario Virgen de Valme, Sevilla. Daniel Tognetti: Clinica Sagrada Familia, Barcelona. Carlos García Redruello, David Mosquera Rodríguez, Eva María Menor Fernández, Sabela Vara Adrio, Vanesa Gómez Casal, Marta Segura Pensado, María Digna Rivas Vilas, Amaia García Sagastume: Hospital de Vigo, Vigo. Raul de Pablo Sánchez, David Pestaña Laguna, Tommaso Bardi: Hospital Universitario Ramón y Cajal, Madrid. Carmen Gómez Gonzalez, Maria Luisa Gascón Castillo: Hospital Universitario Virgen del Rocio, Sevilla. José Garnacho-Montero: Hospital Universitario Virgen Macarena, Sevilla. Joan Ramon Masclans, Ana Salazar Degracia, Judit Bigas, Rosana Muñoz-Bermúdez, Clara Vilà-Vilardel, Francisco Parrilla, Irene Dot, Ana Zapatero, Yolanda Díaz, María Pilar Gracia, Purificación Pérez, Andrea Castellví, Cristina Climent: Hospital del Mar, Barcelona. Lidia Serra, Laura Barbena, Iosune Cano: Consorci Sanitari del Maresme, Barcelona. Alba Herraiz, Pilar Marcos, Laura Rodríguez, Maria Teresa Sariñena, Ana Sánchez: Hospital Universitari Germans Trias i Pujol, Badalona. Juan Fernando Masa Jimenez: Hospital Universitario San Pedro de Alcántara, Cáceres. Gemma Gomà: Hospital Parc Taulí, Sabadell. Mercedes Ibarz, Diego De Mendoza: Hospital Universitari Sagrat Cor, Bacelona. Enric Barbeta, Victoria Alcaraz-Serrano, Joan Ramon Badia, Manuel Castella, Leticia Bueno, Laia Fernandez Barat, Catia Cillóniz, Pamela Conde, Javier Fernández, Albert Gabarrus, Karsa Kiarostami, Alexandre López- Gavín, Cecilia L Mantellini, Carla Speziale, Nil Vázquez, Hua Yang, Minlan Yang, Carlos Ferrando, Pedro Castro, Marta Arrieta, Jose Maria Nicolas, Rut Andrea: Hospital Clinic, Barcelona. Marta Barroso, Sergio Álvarez, Dario Garcia-Gasulla, Adrián Tormos: Barcelona supercomputing Center, Barcelona. Cesar Aldecoa, Rubén Herrán-Monge, José Ángel Berezo García, Pedro Enríquez Giraudo: Hospital Rio Hortega, Valladolid. Pablo Cardinal Fernández, Alberto Rubio López, Orville Báez Pravia: Hospitales HM, Madrid. Leire Pérez Bastida, Antonjo Alvarez Ruiz: Complejo Asistencial Universitario de Palencia, Palencia. Anna Parera Pous: Hospital Universitari MutuaTerrassa, Terrassa. Ana López Lago, Eva Saborido Paz, Patricia Barral Segade: Hospital de Santiago de Compostela, Santiago. Manuel Valledor Mendez: Hospital San Agustin, Aviles. Luciano Aguilera: Hospital Basurto, Basurto. Esther López-Ramos, Ángela Leonor Ruiz-García, Belén Beteré: Hospital Universitario Principe Asturias , Alcala de Henares. Rafael Blancas: Hospital Universitario del Tajo, Aranjuez. Cristina Dólera, Gloria Perez Planelles, Enrique Marmol Peis, Maria Dolores Martinez Juan, Miriam Ruiz Miralles, Eva Perez Rubio, Maria Van der Hofstadt Martin-Montalvo, Tatiana Villada Warrington: Hospital Universitario Sant Joan d’Alacant, Alicante. Sara Guadalupe Moreno Cano: Hospital de Jerez, Jerez. Federico Gordo: Hospital Universitario del Henares, Coslada. Basilisa Martinez Palacios: Hospital Universitario Infanta Cristina, Parla. Maria Teresa Nieto: Hospital de Segovia, Segovia. Sergio Ossa: Hospital de Burgos, Burgos. Ana Ortega: Hospital Montecelo, Pontevedra. Miguel Sanchez: Hospital Clinico, Madrid. Bitor Santacoloma: Hospital Galdakao, Galdakao.

Funding Information:
Financial support was provided by the Instituto de Salud Carlos III de Madrid (COV20/00110, ISCIII); Fondo Europeo de Desarrollo Regional (FEDER); "Una manera de hacer Europa"; and Centro de Investigación Biomedica En Red—Enfermedades Respiratorias (CIBERES). DdGC has received financial support from the Instituto de Salud Carlos III (Miguel Servet 2020: CP20/00041), co-funded by European Social Fund (ESF)/“Investing in your future”. CC received a grant from the Fondo de Investigación Sanitaria (PI19/00207), Instituto de Salud Carlos III, co-funded by the European Union. Role of the Funder/Sponsor: The funding sources had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Publisher Copyright:
© 2022, Springer-Verlag GmbH Germany, part of Springer Nature.

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