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 studySetting: Critical Care UnitsPatients: Adult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain. INTERVENTIONS: corticosteroids vs no corticosteroidsMain 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 2,017 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.
ABSTRACT
La pandemia del COVID-19 ha obligado a implementar medidas que impactaron el funcionamiento normal de las universidades peruanas, llevando al cierre inmediato de las actividades presenciales y, en medio de la contingencia, a implementar acciones de emergencia que permitieran la continuidad de la entrega del servicio a sus estudiantes, adoptando la educación a distancia mediada por Tecnologías de Información y Comunicación. El objetivo del artículo es analizar la responsabilidad social de la universidad peruana en el marco de la implementación de la educación virtual en el contexto de pandemia. La metodología abordada tiene un enfoque cualitativo, de tipo documental, utilizando el análisis de contenido. Los resultados revelan que existe una responsabilidad social limitada en el sector universitario, en función de su escasa participación en la construcción y diseño de clases a través de las plataformas tecnológicas disponibles, para implementar la educación virtual. Se concluye que las universidades de Perú enfrentan exigencias para asumir de forma más eficiente y responsable los diferentes procesos que ellas desarrollan en la modalidad virtual (docencia, investigación, extensión), con el propósito de honrar las normas y procedimientos expuestos en el contexto normativo que regula su actuación en el contexto de pandemia.Alternate :The COVID-19 pandemic has forced the implementation of measures that impacted the normal functioning of Peruvian universities, leading to the immediate closure of face-to-face activities and, in the midst of the contingency, implementing emergency actions that would allow the continuity of service delivery. to their students, adopting distance education mediated by Information and Communication Technologies. The objective of the article is to analyze the social responsibility of the Peruvian university in the framework of the implementation of virtual education in the context of the pandemic. The methodology used is a qualitative, documentary approach, using content analysis. The results reveal that there is limited social responsibility in the university sector, due to its scarce participation in the construction and design of classes through the available technological platforms, to implement virtual education. It is concluded that universities in Peru face demands to assume in a more efficient and responsible way the different processes that they develop in the virtual modality (teaching, research, extension), with the purpose of honoring the norms and procedures exposed in the normative context that regulates their performance in the context of pandemic.