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A Differential Therapeutic consideration for use of Corticosteroids according to Established COVID-19 Clinical Phenotypes in Critically ill Patients.
Moreno, Gerard; Ruiz-Botella, Manuel; Martín-Loeches, Ignacio; Alvarez, Josep Gómez; Herrera, María Jiménez; Bodí, María; Armestar, Fernando; Parra, Asunción Marques; Estella, Ángel; Trefler, Sandra; García, Ruth Jorge; Paya, Josefa Murcia; Cortes, Pablo Vidal; Díaz, Emili; Ferrer, Ricard; Albaya-Moreno, Antonio; Socias-Crespi, Lorenzo; Goytisolo, Josep Maria Bonell; Chinesta, Susana Sancho; Loza, Ana; Espina, Lorena Forcelledo; Laderas, Juan Carlos Pozo; deAlba-Aparicio, María; Montori, Laura Sánchez; Perapoch, Immaculada Vallverdú; Hidalgo, Virginia; Gutiérrez, Virginia Fraile; Ortega, Ana Mª Casamitjana; Serrano, Fátima Martín; Nieto, Mercedes; Cortes, María Blasco; Marín-Corral, Judith; Solé-Violán, Jordi; Rodríguez, Alejandro.
  • Moreno G; ICU Hospital Universitario Joan XXIII/URV/IISPV, Tarragona, Spain.
  • Ruiz-Botella M; Tarragona Health Data Research working group (THeDaR)- ICU Hospital Universitario Joan XXIII, Tarragona, Spain.
  • Martín-Loeches I; Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland.
  • Alvarez JG; Tarragona Health Data Research working group (THeDaR)- ICU Hospital Universitario Joan XXIII, Tarragona, Spain.
  • Herrera MJ; Dean Nursing Faculty, Universitat Rovira i Virgili, Tarragona, Spain.
  • Bodí M; ICU Hospital Universitario Joan XXIII/URV/IISPV, Tarragona, Spain.
  • Armestar F; CIBERES/ CIBERESUCICOVID, Spain.
  • Parra AM; ICU Hospital Universitario German Trias I Pujol, Badalona, Spain.
  • Estella Á; ICU Hospital de la Ribera, Alzira, Spain.
  • Trefler S; ICU Hospital Universitario de Jerez, Jerez de la Frontera, Spain.
  • García RJ; ICU Hospital Universitario Joan XXIII/URV/IISPV, Tarragona, Spain.
  • Paya JM; ICU Hospital Nuestra Señora de Gracia, Zaragoza, Spain.
  • Cortes PV; UCI Hospital Santa Lucia, Cartagena, Spain.
  • Díaz E; UCI Complejo Hospitalario Universitario de Ourense, Ourense, Spain.
  • Ferrer R; UCI Hospital Parc Tauli/UAB/CIBERES, Spain.
  • Albaya-Moreno A; UCI Hospital universitario Vall d'Hebron, Barcelona, Spain.
  • Socias-Crespi L; ICU Hospital Universitario de Guadalajara, Guadalajara, Spain.
  • Goytisolo JMB; UCI Hospital Universitario Son Llatzer, Palma de Mallorca, Spain.
  • Chinesta SS; UCI Hospital QuironSalud Palmaplanas, Palma de Mallorca, Spain.
  • Loza A; ICU Hospital Universitario y Politécnico La Fe, Valencia, Spain.
  • Espina LF; ICU Hospital universitario Nuestra Señora de Valme, Sevilla, Spain.
  • Laderas JCP; ICU Hospital Central de Asturias, Grupo de Investigación de Microbiología Traslacional del ISPA, Oviedo, Spain.
  • deAlba-Aparicio M; ICU Hospital Universitario Reina Sofía, Córdoba, Spain.
  • Montori LS; ICU Hospital Universitario Reina Sofía, Córdoba, Spain.
  • Perapoch IV; ICU Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
  • Hidalgo V; ICU Hospital Universitario Sant Joan, Reus, Spain.
  • Gutiérrez VF; ICU Hospital Complejo Asistencial de Segovia, Segovia, Spain.
  • Ortega AMC; ICU Hospital Universitario Rio Hortega, Valladolid, Spain.
  • Serrano FM; UCI Complejo Hospitalario Universitario Insular - Materno Infantil, Las Palmas de Gran Canaria, Spain.
  • Nieto M; UCI Hospital la Moncloa, Madrid, Spain.
  • Cortes MB; UCI Hospital Clínico San Carlos, Madrid, Spain.
  • Marín-Corral J; UCI Hospital Clinico Universitario, Valencia, Spain.
  • Solé-Violán J; ICU Hospital del Mar / GREPAC - IMIM, Barcelona (Spain) and - Division of Pulmonary Diseases & Critical Care Medicine, UTH San Antonio, San Antonio, TX, USA.
  • Rodríguez A; ICU Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain.
Med Intensiva ; 2021 Oct 26.
Article in Spanish | MEDLINE | ID: covidwho-1482804
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 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.
Keywords

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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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