by Pablo Monedero, Alfredo Gea, Pedro Castro, Angel M.
Candela-Toha, María L. Hernández-Sanz, Egoitz Arruti, Jesús Villar and Carlos
Ferrando
Critical Care volume 25,
Article number: 2 (2021)
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.
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