A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients
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 critic...
| Authors: | ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; |
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| Format: | Article |
| Status: | Published version |
| Publication date: | 2023 |
| Country: | España |
| Institution: | INCLIVA |
| Repository: | r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA |
| OAI Identifier: | oai:incliva.fundanetsuite.com:p18655 |
| Online Access: | https://incliva.portalinvestigacion.com/publicaciones/18655 |
| Access Level: | Open access |
| Keyword: | COVID-19 Corticosteroids Phenotypes ICU mortality SARS-CoV2-pneumonia Unsupervised clustering |
| _version_ | 1878739193241272320 |
|---|---|
| author | Moreno, G |
| author2 | Ruiz-Botella, M Martín-Loeches, Alvarez, JG Herrera, MJ Bodí, M Armestar, F Parra, AM Estella, A Trefler, S García, RJ Paya, JM Cortes, PV Díaz, E Ferrer, R Albaya-Moreno, A Socias-Crespi, L Goytisolo, JMB Chinesta, SS Loza, A Espina, LF Laderas, JCP DeAlba-Aparicio, M Montori, LS Perapoch, IV Hidalgo, Gutiérrez, VF Ortega, AMC Serrano, FM Nieto, M Cortes, MB Marín-Corral, J Solé-Violán, J Rodríguez, A |
| author2_role | author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| author_browse | Albaya-Moreno, A Alvarez, JG Armestar, F Bodí, M Chinesta, SS Cortes, MB Cortes, PV DeAlba-Aparicio, M Díaz, E Espina, LF Estella, A Ferrer, R García, RJ Goytisolo, JMB Gutiérrez, VF Herrera, MJ Hidalgo, Laderas, JCP Loza, A Martín-Loeches, Marín-Corral, J Montori, LS Moreno, G Nieto, M Ortega, AMC Parra, AM Paya, JM Perapoch, IV Rodríguez, A Ruiz-Botella, M Serrano, FM Socias-Crespi, L Solé-Violán, J Trefler, S |
| author_facet | Moreno, G Ruiz-Botella, M Martín-Loeches, Alvarez, JG Herrera, MJ Bodí, M Armestar, F Parra, AM Estella, A Trefler, S García, RJ Paya, JM Cortes, PV Díaz, E Ferrer, R Albaya-Moreno, A Socias-Crespi, L Goytisolo, JMB Chinesta, SS Loza, A Espina, LF Laderas, JCP DeAlba-Aparicio, M Montori, LS Perapoch, IV Hidalgo, Gutiérrez, VF Ortega, AMC Serrano, FM Nieto, M Cortes, MB Marín-Corral, J Solé-Violán, J Rodríguez, A |
| author_role | author |
| collection | r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA |
| description | 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. (c) 2021 Elsevier Espana, S.L.U. y SEMICYUC. All rights reserved. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | ES_bcd4fe74eee35d0fedfc82fdad5fa0ed |
| institution | INCLIVA |
| instname_str | INCLIVA |
| network_acronym_str | ES |
| network_name_str | España |
| oai_identifier_str | oai:incliva.fundanetsuite.com:p18655 |
| publishDate | 2023 |
| publishDateSort | 2023 |
| publisher | ELSEVIER ESPANA SLU |
| publisherStr | ELSEVIER ESPANA SLU |
| reponame_str | r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA |
| spelling | A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients Moreno, G Ruiz-Botella, M Martín-Loeches, Alvarez, JG Herrera, MJ Bodí, M Armestar, F Parra, AM Estella, A Trefler, S García, RJ Paya, JM Cortes, PV Díaz, E Ferrer, R Albaya-Moreno, A Socias-Crespi, L Goytisolo, JMB Chinesta, SS Loza, A Espina, LF Laderas, JCP DeAlba-Aparicio, M Montori, LS Perapoch, IV Hidalgo, Gutiérrez, VF Ortega, AMC Serrano, FM Nieto, M Cortes, MB Marín-Corral, J Solé-Violán, J Rodríguez, A COVID-19 Corticosteroids Phenotypes ICU mortality SARS-CoV2-pneumonia Unsupervised clustering 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. (c) 2021 Elsevier Espana, S.L.U. y SEMICYUC. All rights reserved. ELSEVIER ESPANA SLU https://incliva.portalinvestigacion.com/publicaciones/18655 |
| spellingShingle | A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients Moreno, G COVID-19 Corticosteroids Phenotypes ICU mortality SARS-CoV2-pneumonia Unsupervised clustering |
| status_str | publishedVersion |
| title | A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients |
| title_full | A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients |
| title_fullStr | A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients |
| title_full_unstemmed | A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients |
| title_short | A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients |
| title_sort | A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients |
| topic | COVID-19 Corticosteroids Phenotypes ICU mortality SARS-CoV2-pneumonia Unsupervised clustering |
| topic_facet | COVID-19 Corticosteroids Phenotypes ICU mortality SARS-CoV2-pneumonia Unsupervised clustering |
| url | https://incliva.portalinvestigacion.com/publicaciones/18655 |