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Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study.
Torres, Antoni; Motos, Ana; Cillóniz, Catia; Ceccato, Adrián; Fernández-Barat, Laia; Gabarrús, Albert; Bermejo-Martin, Jesús; Ferrer, Ricard; Riera, Jordi; Pérez-Arnal, Raquel; García-Gasulla, Dario; Peñuelas, Oscar; Lorente, José Ángel; de Gonzalo-Calvo, David; Almansa, Raquel; Menéndez, Rosario; Palomeque, Andrea; Villar, Rosario Amaya; Añón, José M; Balan Mariño, Ana; Barberà, Carme; Barberán, José; Blandino Ortiz, Aaron; Boado, Maria Victoria; Bustamante-Munguira, Elena; Caballero, Jesús; Cantón-Bulnes, María Luisa; Carbajales Pérez, Cristina; Carbonell, Nieves; Catalán-González, Mercedes; de Frutos, Raul; Franco, Nieves; Galbán, Cristóbal; Gumucio-Sanguino, Víctor D; de la Torre, Maria Del Carmen; Díaz, Emili; Estella, Ángel; Gallego, Elena; García Garmendia, José Luis; Gómez, José M; Huerta, Arturo; García, Ruth Noemí Jorge; Loza-Vázquez, Ana; Marin-Corral, Judith; Martin Delgado, María Cruz; Martínez de la Gándara, Amalia; Martínez Varela, Ignacio; López Messa, Juan; Albaiceta, Guillermo M; Nieto, Maite.
  • Torres A; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. atorres@clinic.cat.
  • Motos A; Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain. atorres@clinic.cat.
  • Cillóniz C; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, C/Casanova 143, 08036, Barcelona, Spain. atorres@clinic.cat.
  • Ceccato A; Department of Pulmonary Medicine, Hospital Clinic of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain. atorres@clinic.cat.
  • Fernández-Barat L; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. amotos@clinic.cat.
  • Gabarrús A; Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain. amotos@clinic.cat.
  • Bermejo-Martin J; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, C/Casanova 143, 08036, Barcelona, Spain. amotos@clinic.cat.
  • Ferrer R; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
  • Riera J; Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain.
  • Pérez-Arnal R; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, C/Casanova 143, 08036, Barcelona, Spain.
  • García-Gasulla D; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
  • Peñuelas O; Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain.
  • Lorente JÁ; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, C/Casanova 143, 08036, Barcelona, Spain.
  • de Gonzalo-Calvo D; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
  • Almansa R; Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain.
  • Menéndez R; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, C/Casanova 143, 08036, Barcelona, Spain.
  • Palomeque A; Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain.
  • Villar RA; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, C/Casanova 143, 08036, Barcelona, Spain.
  • Añón JM; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
  • Balan Mariño A; Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, Salamanca, Spain.
  • Barberà C; Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain.
  • Barberán J; Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain.
  • Blandino Ortiz A; Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain.
  • Boado MV; Barcelona Supercomputing Centre (BSC), Barcelona, Spain.
  • Bustamante-Munguira E; Barcelona Supercomputing Centre (BSC), Barcelona, Spain.
  • Caballero J; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
  • Cantón-Bulnes ML; Hospital Universitario de Getafe, Madrid, Spain.
  • Carbajales Pérez C; Universidad Europea, Madrid, Spain.
  • Carbonell N; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
  • Catalán-González M; Hospital Universitario de Getafe, Madrid, Spain.
  • de Frutos R; Universidad Europea, Madrid, Spain.
  • Franco N; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
  • Galbán C; Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.
  • Gumucio-Sanguino VD; Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, Salamanca, Spain.
  • de la Torre MDC; Pulmonary Department, University and Polytechnic Hospital La Fe, Valencia, Spain.
  • Díaz E; Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain.
  • Estella Á; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, C/Casanova 143, 08036, Barcelona, Spain.
  • Gallego E; Intensive Care Clinical Unit, Hospital Universitario Virgen de Rocío, Seville, Spain.
  • García Garmendia JL; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
  • Gómez JM; Servicio de Medicina Intensiva. Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
  • Huerta A; Hospital Universitario San Agustín, Asturias, Spain.
  • García RNJ; Hospital Santa Maria, IRBLleida, Lleida, Spain.
  • Loza-Vázquez A; Hospital Universitario HM Montepríncipe, Universidad San Pablo-CEU, Madrid, Spain.
  • Marin-Corral J; Servicio de Medicina Intensiva, Hospital Universitario Ramón y Cajal, Madrid, Spain.
  • Martin Delgado MC; Hospital Universitario de Cruces, Barakaldo, Spain.
  • Martínez de la Gándara A; Department of Intensive Care Medicine, Hospital Clínico Universitario Valladolid, Valladolid, Spain.
  • Martínez Varela I; Critical Care Department, Hospital Universitari Arnau de Vilanova; IRBLleida, Lleida, Spain.
  • López Messa J; Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain.
  • Albaiceta GM; Intensive Care Unit, Hospital Álvaro Cunqueiro, Vigo, Spain.
  • Nieto M; Intensive Care Unit, Hospital Clínico y Universitario de Valencia, Valencia, Spain.
Intensive Care Med ; 48(7): 850-864, 2022 07.
Article in English | MEDLINE | ID: covidwho-1899125
ABSTRACT

PURPOSE:

Although there is evidence supporting the benefits of corticosteroids in patients affected with severe coronavirus disease 2019 (COVID-19), there is little information related to their potential benefits or harm in some subgroups of patients admitted to the intensive care unit (ICU) with COVID-19. We aim to investigate to find candidate variables to guide personalized treatment with steroids in critically ill patients with COVID-19.

METHODS:

Multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs. The primary outcome was 90-day mortality. Subsequent analyses in clinically relevant subgroups by age, ICU baseline illness severity, organ damage, laboratory findings and mechanical ventilation were performed. High doses of corticosteroids (≥ 12 mg/day equivalent dexamethasone dose), early administration of corticosteroid treatment (< 7 days since symptom onset) and long term of corticosteroids (≥ 10 days) were also investigated.

RESULTS:

Between February 2020 and October 2021, 4226 patients were included. Of these, 3592 (85%) patients had received systemic corticosteroids during hospitalisation. In the propensity-adjusted multivariable analysis, the use of corticosteroids was protective for 90-day mortality in the overall population (HR 0.77 [0.65-0.92], p = 0.003) and in-hospital mortality (SHR 0.70 [0.58-0.84], p < 0.001). Significant effect modification was found after adjustment for covariates using propensity score for age (p = 0.001 interaction term), Sequential Organ Failure Assessment (SOFA) score (p = 0.014 interaction term), and mechanical ventilation (p = 0.001 interaction term). We observed a beneficial effect of corticosteroids on 90-day mortality in various patient subgroups, including those patients aged ≥ 60 years; those with higher baseline severity; and those receiving invasive mechanical ventilation at ICU admission. Early administration was associated with a higher risk of 90-day mortality in the overall population (HR 1.32 [1.14-1.53], p < 0.001). Long-term use was associated with a lower risk of 90-day mortality in the overall population (HR 0.71 [0.61-0.82], p < 0.001). No effect was found regarding the dosage of corticosteroids. Moreover, the use of corticosteroids was associated with an increased risk of nosocomial bacterial pneumonia and hyperglycaemia.

CONCLUSION:

Corticosteroid in ICU-admitted patients with COVID-19 may be administered based on age, severity, baseline inflammation, and invasive mechanical ventilation. Early administration since symptom onset may prove harmful.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Drug Treatment Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Intensive Care Med Year: 2022 Document Type: Article Affiliation country: S00134-022-06726-w

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Drug Treatment Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Intensive Care Med Year: 2022 Document Type: Article Affiliation country: S00134-022-06726-w