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Monedero, Pablo; Gea, Alfredo; Castro, Pedro; Candela-Toha, Angel M.; Hernández-Sanz, María L.; Arruti, Egoitz; Villar, Jesús; Ferrando, Carlos; Monedero, Pablo; Gea, Alfredo; Castro, Pedro; Candela-Toha, Angel M.; Vendrell, Marina; Sánchez-Etayo, Gerard; Alcón, Amalia; Belda, Isabel; Agustí, Mercé; Carramiñana, Albert; Gracia, Isabel; Panzeri, Miriam; León, Irene; Balust, Jaume; Navarro, Ricard; Arguís, María José; [...]

Early corticosteroids are associated with lower mortality in critically ill patients with COVID-19: a cohort study

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  • Media type: E-Article
  • Title: Early corticosteroids are associated with lower mortality in critically ill patients with COVID-19: a cohort study
  • Contributor: Monedero, Pablo; Gea, Alfredo; Castro, Pedro; Candela-Toha, Angel M.; Hernández-Sanz, María L.; Arruti, Egoitz; Villar, Jesús; Ferrando, Carlos; Monedero, Pablo; Gea, Alfredo; Castro, Pedro; Candela-Toha, Angel M.; Vendrell, Marina; Sánchez-Etayo, Gerard; Alcón, Amalia; Belda, Isabel; Agustí, Mercé; Carramiñana, Albert; Gracia, Isabel; Panzeri, Miriam; León, Irene; Balust, Jaume; Navarro, Ricard; Arguís, María José; [...]
  • Published: Springer Science and Business Media LLC, 2021
  • Published in: Critical Care, 25 (2021) 1
  • Language: English
  • DOI: 10.1186/s13054-020-03422-3
  • ISSN: 1364-8535
  • Origination:
  • Footnote:
  • Description: Abstract Background Critically ill patients with coronavirus disease 19 (COVID-19) have a high fatality rate likely due to a dysregulated immune response. Corticosteroids could attenuate this inappropriate response, although there are still some concerns regarding its use, timing, and dose. Methods This is a nationwide, prospective, multicenter, observational, cohort study in critically ill adult patients with COVID-19 admitted into Intensive Care Units (ICU) in Spain from 12th March to 29th June 2020. Using a multivariable Cox model with inverse probability weighting, we compared relevant outcomes between patients treated with early corticosteroids (before or within the first 48 h of ICU admission) with those who did not receive early corticosteroids (delayed group) or any corticosteroids at all (never group). Primary endpoint was ICU mortality. Secondary endpoints included 7-day mortality, ventilator-free days, and complications. Results A total of 691 patients out of 882 (78.3%) received corticosteroid during their hospital stay. Patients treated with early-corticosteroids (n = 485) had lower ICU mortality (30.3% vs. never 36.6% and delayed 44.2%) and lower 7-day mortality (7.2% vs. never 15.2%) compared to non-early treated patients. They also had higher number of ventilator-free days, less length of ICU stay, and less secondary infections than delayed treated patients. There were no differences in medical complications between groups. Of note, early use of moderate-to-high doses was associated with better outcomes than low dose regimens. Conclusion Early use of corticosteroids in critically ill patients with COVID-19 is associated with lower mortality than no or delayed use, and fewer complications than delayed use.
  • Access State: Open Access