Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Torres Antoni, Motos Ana, Cillóniz Catia, Ceccato Adrián, Fernández-Barat Laia, Gabarrús Albert, Bermejo-Martin Jesús, Ferrer Ricard, Riera Jordi, Pérez-Arnal Raquel, García-Gasulla Dario, Peñuelas Oscar, Lorente José Ángel, de Gonzalo-Calvo David, Almansa Raquel, Menéndez Rosario, Palomeque Andrea, Villar Rosario Amaya, Añón José M, Balan Mariño Ana, Barberà Carme, Barberán José, Blandino Ortiz Aaron, Boado Maria Victoria, Bustamante-Munguira Elena, Caballero Jesús, Cantón-Bulnes María Luisa, Carbajales Pérez Cristina, Carbonell Nieves, Catalán-González Mercedes, de Frutos Raul, Franco Nieves, Galbán Cristóbal, Gumucio-Sanguino Víctor D, de la Torre Maria Del Carmen, Díaz Emili, Estella Ángel, Gallego Elena, García Garmendia José Luis, Gómez José M, Huerta Arturo, García Ruth Noemí Jorge, Loza-Vázquez Ana, Marin-Corral Judith, Martin Delgado María Cruz, Martínez de la Gándara Amalia, Martínez Varela Ignacio, López Messa Juan, Albaiceta Guillermo M, Nieto Maite, Novo Mariana Andrea, Peñasco Yhivian, Pérez-García Felipe, Pozo-Laderas Juan Carlos, Ricart Pilar, Sagredo Victor, Sánchez-Miralles Angel, Sancho Chinesta Susana, Serra-Fortuny Mireia, Socias Lorenzo, Solé-Violan Jordi, Suarez-Sipmann Fernando, Tamayo Lomas Luis, Trenado José, Úbeda Alejandro, Valdivia Luis Jorge, Vidal Pablo, Barbé Ferran, CIBERESUCICOVID Project Investigators
Аннотация
METHODS: Multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs. The primary outcome was 90-day mortality. Subsequent analyses in clinically relevant subgroups by age, ICU baseline illness severity, organ damage, laboratory findings and mechanical ventilation were performed. High doses of corticosteroids (≥ 12 mg/day equivalent dexamethasone dose), early administration of corticosteroid treatment (< 7 days since symptom onset) and long term of corticosteroids (≥ 10 days) were also investigated.
RESULTS: Between February 2020 and October 2021, 4226 patients were included. Of these, 3592 (85%) patients had received systemic corticosteroids during hospitalisation. In the propensity-adjusted multivariable analysis, the use of corticosteroids was protective for 90-day mortality in the overall population (HR 0.77 [0.65-0.92], p = 0.003) and in-hospital mortality (SHR 0.70 [0.58-0.84], p < 0.001). Significant effect modification was found after adjustment for covariates using propensity score for age (p = 0.001 interaction term), Sequential Organ Failure Assessment (SOFA) score (p = 0.014 interaction term), and mechanical ventilation (p = 0.001 interaction term). We observed a beneficial effect of corticosteroids on 90-day mortality in various patient subgroups, including those patients aged ≥ 60 years; those with higher baseline severity; and those receiving invasive mechanical ventilation at ICU admission. Early administration was associated with a higher risk of 90-day mortality in the overall population (HR 1.32 [1.14-1.53], p < 0.001). Long-term use was associated with a lower risk of 90-day mortality in the overall population (HR 0.71 [0.61-0.82], p < 0.001). No effect was found regarding the dosage of corticosteroids. Moreover, the use of corticosteroids was associated with an increased risk of nosocomial bacterial pneumonia and hyperglycaemia.
CONCLUSION: Corticosteroid in ICU-admitted patients with COVID-19 may be administered based on age, severity, baseline inflammation, and invasive mechanical ventilation. Early administration since symptom onset may prove harmful.