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...

Full description

Authors: Moreno, G; Ruiz-Botella, M; Martin-Loeches, I; 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, V; Gutiérrez, VF; Ortega, AMC; Serrano, FM; Nieto, M; Cortes, MB; Marín-Corral, J; Solé-Violán, J; Rodríguez, A
Format: Article
Status:Published version
Publication date:2023
Country:España
Institution:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repository:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p16094
Online Access:https://fisabio.portalinvestigacion.com/publicaciones/16094
Access Level:Open access
Keyword:COVID-19
Corticosteroids
Phenotypes
ICU mortality
SARS-CoV2-pneumonia
Unsupervised clustering
Summary: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.

Similar Items