A Differential Therapeutic consideration for use of Corticosteroids according to Established COVID-19 Clinical Phenotypes in Critically ill Patients.
Med Intensiva
; 2021 Oct 26.
Article
in Spanish
| MEDLINE | ID: covidwho-2243484
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 (OR1.0,95%CI0.98-1.15). 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.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Type of study:
Observational study
/
Prognostic study
Language:
Spanish
Year:
2021
Document Type:
Article
Affiliation country:
J.medin.2021.10.002
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