Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study

COVID-19-associated acute respiratory distress syndrome; Corticosteroids; Intensive care unit

Detalles Bibliográficos
Autores: Moreno, Gerard, Carbonell, Raquel, Martin‑Loeches, Ignacio, Sole‑Violan, Jordi, Gómez, Josep, Papiol Gallofré, Elisabeth, Ferrer Roca, Ricard, Correig Fraga, Eudald
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Departament de Salut de la Generalitat de Catalunya (DS)
Repositorio:Scientia. Dipòsit d'Informació Digital del Departament de Salut
OAI Identifier:oai:scientiasalut.gencat.cat:11351/7528
Acceso en línea:https://hdl.handle.net/11351/7528
Access Level:acceso abierto
Palabra clave:COVID-19 (Malaltia) - Mortalitat
Respiració artificial - Complicacions
DISEASES::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections
Other subheadings::Other subheadings::Other subheadings::Other subheadings::/mortality
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Therapeutics::Emergency Treatment::Resuscitation::Therapeutics::Respiration, Artificial
Other subheadings::Other subheadings::Other subheadings::/adverse effects
ENFERMEDADES::virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus
Otros calificadores::Otros calificadores::Otros calificadores::Otros calificadores::/mortalidad
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::terapéutica::tratamiento de urgencia::resucitación::terapéutica::respiración artificial
Otros calificadores::Otros calificadores::Otros calificadores::/efectos adversos
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oai_identifier_str oai:scientiasalut.gencat.cat:11351/7528
network_acronym_str ES
network_name_str España
repository_id_str
dc.title.none.fl_str_mv Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study
title Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study
spellingShingle Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study
Moreno, Gerard
COVID-19 (Malaltia) - Mortalitat
Respiració artificial - Complicacions
DISEASES::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections
Other subheadings::Other subheadings::Other subheadings::Other subheadings::/mortality
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Therapeutics::Emergency Treatment::Resuscitation::Therapeutics::Respiration, Artificial
Other subheadings::Other subheadings::Other subheadings::/adverse effects
ENFERMEDADES::virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus
Otros calificadores::Otros calificadores::Otros calificadores::Otros calificadores::/mortalidad
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::terapéutica::tratamiento de urgencia::resucitación::terapéutica::respiración artificial
Otros calificadores::Otros calificadores::Otros calificadores::/efectos adversos
title_short Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study
title_full Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study
title_fullStr Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study
title_full_unstemmed Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study
title_sort Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study
dc.creator.none.fl_str_mv Moreno, Gerard
Carbonell, Raquel
Martin‑Loeches, Ignacio
Sole‑Violan, Jordi
Gómez, Josep
Papiol Gallofré, Elisabeth
Ferrer Roca, Ricard
Correig Fraga, Eudald
author Moreno, Gerard
author_facet Moreno, Gerard
Carbonell, Raquel
Martin‑Loeches, Ignacio
Sole‑Violan, Jordi
Gómez, Josep
Papiol Gallofré, Elisabeth
Ferrer Roca, Ricard
Correig Fraga, Eudald
author_role author
author2 Carbonell, Raquel
Martin‑Loeches, Ignacio
Sole‑Violan, Jordi
Gómez, Josep
Papiol Gallofré, Elisabeth
Ferrer Roca, Ricard
Correig Fraga, Eudald
author2_role author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Institut Català de la Salut
[Moreno G, Carbonell R] Universitat Autònoma de Barcelona, Bellaterra, Spain. Critical Care Department, Joan XXIII University Hospital, 43005 Tarragona, Spain. [Martin-Loeches I] Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s Hospital, Dublin, Ireland. [Solé-Violán J] Critical Care Department, Doctor Negrín University Hospital, Gran Canaria, Spain. [Correig i Fraga E] Department of Biostatistics, University of Rovira i Virgili (URV), Reus, Spain. [Gómez J] Universitat Autònoma de Barcelona, Bellaterra, Spain. Critical Care Department, Joan XXIII University Hospital, 43005 Tarragona, Spain. Tarragona Health Data Research Working Group (THeDaR), Joan XXIII University Hospital, Tarragona, Spain. [Papiol E] Unitat de Cures Intensives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Ferrer R] Unitat de Cures Intensives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca en Xoc, Disfunció Orgànica i Ressuscitació, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
dc.subject.none.fl_str_mv COVID-19 (Malaltia) - Mortalitat
Respiració artificial - Complicacions
DISEASES::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections
Other subheadings::Other subheadings::Other subheadings::Other subheadings::/mortality
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Therapeutics::Emergency Treatment::Resuscitation::Therapeutics::Respiration, Artificial
Other subheadings::Other subheadings::Other subheadings::/adverse effects
ENFERMEDADES::virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus
Otros calificadores::Otros calificadores::Otros calificadores::Otros calificadores::/mortalidad
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::terapéutica::tratamiento de urgencia::resucitación::terapéutica::respiración artificial
Otros calificadores::Otros calificadores::Otros calificadores::/efectos adversos
topic COVID-19 (Malaltia) - Mortalitat
Respiració artificial - Complicacions
DISEASES::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections
Other subheadings::Other subheadings::Other subheadings::Other subheadings::/mortality
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Therapeutics::Emergency Treatment::Resuscitation::Therapeutics::Respiration, Artificial
Other subheadings::Other subheadings::Other subheadings::/adverse effects
ENFERMEDADES::virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus
Otros calificadores::Otros calificadores::Otros calificadores::Otros calificadores::/mortalidad
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::terapéutica::tratamiento de urgencia::resucitación::terapéutica::respiración artificial
Otros calificadores::Otros calificadores::Otros calificadores::/efectos adversos
description COVID-19-associated acute respiratory distress syndrome; Corticosteroids; Intensive care unit
publishDate 2021
dc.date.none.fl_str_mv 2021
2022
2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/11351/7528
url https://hdl.handle.net/11351/7528
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Annals of Intensive Care;11
https://doi.org/10.1186/s13613-021-00951-0
dc.rights.none.fl_str_mv Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Springer
publisher.none.fl_str_mv Springer
dc.source.none.fl_str_mv Scientia
reponame:Scientia. Dipòsit d'Informació Digital del Departament de Salut
instname:Departament de Salut de la Generalitat de Catalunya (DS)
instname_str Departament de Salut de la Generalitat de Catalunya (DS)
reponame_str Scientia. Dipòsit d'Informació Digital del Departament de Salut
collection Scientia. Dipòsit d'Informació Digital del Departament de Salut
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869403641114263552
spelling Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort studyMoreno, GerardCarbonell, RaquelMartin‑Loeches, IgnacioSole‑Violan, JordiGómez, JosepPapiol Gallofré, ElisabethFerrer Roca, RicardCorreig Fraga, EudaldCOVID-19 (Malaltia) - MortalitatRespiració artificial - ComplicacionsDISEASES::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus InfectionsOther subheadings::Other subheadings::Other subheadings::Other subheadings::/mortalityANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Therapeutics::Emergency Treatment::Resuscitation::Therapeutics::Respiration, ArtificialOther subheadings::Other subheadings::Other subheadings::/adverse effectsENFERMEDADES::virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por CoronavirusOtros calificadores::Otros calificadores::Otros calificadores::Otros calificadores::/mortalidadTÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::terapéutica::tratamiento de urgencia::resucitación::terapéutica::respiración artificialOtros calificadores::Otros calificadores::Otros calificadores::/efectos adversosCOVID-19-associated acute respiratory distress syndrome; Corticosteroids; Intensive care unitSíndrome de dificultad respiratoria aguda asociado a COVID-19; Corticosteroides; Unidad de cuidados intensivosSíndrome de dificultat respiratòria aguda associada a la COVID-19; Corticosteroides; Unitat de cures intensivesBackground Some unanswered questions persist regarding the effectiveness of corticosteroids for severe coronavirus disease 2019 (COVID-19) patients. We aimed to assess the clinical effect of corticosteroids on intensive care unit (ICU) mortality among mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients. Methods This was a retrospective study of prospectively collected data conducted in 70 ICUs (68 Spanish, one Andorran, one Irish), including mechanically ventilated COVID-19-associated ARDS patients admitted between February 6 and September 20, 2020. Individuals who received corticosteroids for refractory shock were excluded. Patients exposed to corticosteroids at admission were matched with patients without corticosteroids through propensity score matching. Primary outcome was all-cause ICU mortality. Secondary outcomes were to compare in-hospital mortality, ventilator-free days at 28 days, respiratory superinfection and length of stay between patients with corticosteroids and those without corticosteroids. We performed survival analysis accounting for competing risks and subgroup sensitivity analysis. Results We included 1835 mechanically ventilated COVID-19-associated ARDS, of whom 1117 (60.9%) received corticosteroids. After propensity score matching, ICU mortality did not differ between patients treated with corticosteroids and untreated patients (33.8% vs. 30.9%; p = 0.28). In survival analysis, corticosteroid treatment at ICU admission was associated with short-term survival benefit (HR 0.53; 95% CI 0.39–0.72), although beyond the 17th day of admission, this effect switched and there was an increased ICU mortality (long-term HR 1.68; 95% CI 1.16–2.45). The sensitivity analysis reinforced the results. Subgroups of age < 60 years, severe ARDS and corticosteroids plus tocilizumab could have greatest benefit from corticosteroids as short-term decreased ICU mortality without long-term negative effects were observed. Larger length of stay was observed with corticosteroids among non-survivors both in the ICU and in hospital. There were no significant differences for the remaining secondary outcomes. Conclusions Our results suggest that corticosteroid treatment for mechanically ventilated COVID-19-associated ARDS had a biphasic time-dependent effect on ICU mortality. Specific subgroups showed clear effect on improving survival with corticosteroid use. Therefore, further research is required to identify treatment-responsive subgroups among the mechanically ventilated COVID-19-associated ARDS patients.Ricardo Barri Casanovas Foundation grant (RBCF2020) and SEMICYUC (Spanish Society of Intensive Care Medicine and Coronary Units). The study sponsors have no role in the study design, data collection, data analysis, data interpretation, writing of the report, or in the decision to submit the paper for publication.SpringerInstitut Català de la Salut[Moreno G, Carbonell R] Universitat Autònoma de Barcelona, Bellaterra, Spain. Critical Care Department, Joan XXIII University Hospital, 43005 Tarragona, Spain. [Martin-Loeches I] Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s Hospital, Dublin, Ireland. [Solé-Violán J] Critical Care Department, Doctor Negrín University Hospital, Gran Canaria, Spain. [Correig i Fraga E] Department of Biostatistics, University of Rovira i Virgili (URV), Reus, Spain. [Gómez J] Universitat Autònoma de Barcelona, Bellaterra, Spain. Critical Care Department, Joan XXIII University Hospital, 43005 Tarragona, Spain. Tarragona Health Data Research Working Group (THeDaR), Joan XXIII University Hospital, Tarragona, Spain. [Papiol E] Unitat de Cures Intensives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Ferrer R] Unitat de Cures Intensives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca en Xoc, Disfunció Orgànica i Ressuscitació, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, SpainVall d'Hebron Barcelona Hospital Campus202220222021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://hdl.handle.net/11351/7528Scientiareponame:Scientia. Dipòsit d'Informació Digital del Departament de Salutinstname:Departament de Salut de la Generalitat de Catalunya (DS)InglésAnnals of Intensive Care;11https://doi.org/10.1186/s13613-021-00951-0Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:scientiasalut.gencat.cat:11351/75282026-06-12T09:38:37Z
score 15.812455

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