A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients

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 Units. Patients: Adult critic...

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Detalles Bibliográficos
Autores: Moreno, G, Ruiz-Botella, M, Martín-Loeches,, Alvarez, JG, Herrera, MJ, Bodí, M, Armestar, F, Parra, AM, Estella, A, Trefler, S, García, RJ, Paya, JM, Cortes, PV, Díaz, E, Ferrer, R, Albaya-Moreno, A, Socias-Crespi, L, Goytisolo, JMB, Chinesta, SS, Loza, A, Espina, LF, Laderas, JCP, DeAlba-Aparicio, M, Montori, LS, Perapoch, IV, Hidalgo,, Gutiérrez, VF, Ortega, AMC, Serrano, FM, Nieto, M, Cortes, MB, Marín-Corral, J, Solé-Violán, J, Rodríguez, A
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p18655
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/18655
Access Level:acceso abierto
Palabra clave:COVID-19
Corticosteroids
Phenotypes
ICU mortality
SARS-CoV2-pneumonia
Unsupervised clustering
Descripción
Sumario: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 Units. Patients: Adult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain. Interventions: Corticosteroids vs. no corticosteroids. Main 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 2017 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. (c) 2021 Elsevier Espana, S.L.U. y SEMICYUC. All rights reserved.

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