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Title: Early corticosteroids are associated with lower mortality in critically ill patients with COVID-19: a cohort study
Author: Monedero, Pablo
Gea, Alfredo
Castro Rebollo, Pedro
Candela Toha, Angel M.
Hernández Sanz, María L.
Arruti, Egoitz
Villar, Jesús
Ferrando, Carlos
COVID-19 Spanish ICU Network
Keywords: COVID-19
Malalts en estat crític
Resposta immunitària
Assaigs clínics
Critically ill
Immune response
Adrenocortical hormones
Clinical trials
Issue Date: 4-Jan-2021
Publisher: BioMed Central
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 frst 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 diferences 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. Keywords: COVID-19, Intensive Care Unit, Corticosteroids, Critically ill patient, Cohort study, Outcomes, Ventilatorfree days, Mortality
Note: Reproducció del document publicat a:
It is part of: Critical Care, 2021, vol. 25, num. 1, p. 2
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ISSN: 1364-8535
Appears in Collections:Articles publicats en revistes (Medicina)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

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