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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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
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spelling A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patientsMoreno, GRuiz-Botella, MMartín-Loeches,Alvarez, JGHerrera, MJBodí, MArmestar, FParra, AMEstella, ATrefler, SGarcía, RJPaya, JMCortes, PVDíaz, EFerrer, RAlbaya-Moreno, ASocias-Crespi, LGoytisolo, JMBChinesta, SSLoza, AEspina, LFLaderas, JCPDeAlba-Aparicio, MMontori, LSPerapoch, IVHidalgo,Gutiérrez, VFOrtega, AMCSerrano, FMNieto, MCortes, MBMarín-Corral, JSolé-Violán, JRodríguez, ACOVID-19CorticosteroidsPhenotypesICU mortalitySARS-CoV2-pneumoniaUnsupervised clusteringObjective: 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.ELSEVIER ESPANA SLU2023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/18655Medicina IntensivaISSN: 02105691ISSNe: 15786749reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAEspañolinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p186552026-06-07T16:35:31Z
dc.title.none.fl_str_mv A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients
title A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients
spellingShingle A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients
Moreno, G
COVID-19
Corticosteroids
Phenotypes
ICU mortality
SARS-CoV2-pneumonia
Unsupervised clustering
title_short A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients
title_full A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients
title_fullStr A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients
title_full_unstemmed A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients
title_sort A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients
dc.creator.none.fl_str_mv 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
author Moreno, G
author_facet 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
author_role author
author2 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
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv COVID-19
Corticosteroids
Phenotypes
ICU mortality
SARS-CoV2-pneumonia
Unsupervised clustering
topic COVID-19
Corticosteroids
Phenotypes
ICU mortality
SARS-CoV2-pneumonia
Unsupervised clustering
description 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.
publishDate 2023
dc.date.none.fl_str_mv 2023
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://incliva.portalinvestigacion.com/publicaciones/18655
url https://incliva.portalinvestigacion.com/publicaciones/18655
dc.language.none.fl_str_mv Español
language_invalid_str_mv Español
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv ELSEVIER ESPANA SLU
publisher.none.fl_str_mv ELSEVIER ESPANA SLU
dc.source.none.fl_str_mv Medicina Intensiva
ISSN: 02105691
ISSNe: 15786749
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.81155

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