A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients.
Med Intensiva (Engl Ed)
; 47(1): 23-33, 2023 01.
Article
em En
| MEDLINE
| ID: mdl-36272908
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
COVID-19
Tipo de estudo:
Clinical_trials
/
Observational_studies
Limite:
Humans
Idioma:
En
Revista:
Med Intensiva (Engl Ed)
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Espanha