Early corticosteroids are associated with lower mortality in critically ill patients with COVID-19: a cohort study
Pablo Monedero, Alfredo Gea, Pedro Castro, Ángel M. Candela-Toha, María L. Hernández-Sanz, Egoitz Arruti, Jesús Villar, Carlos Ferrando, the COVID-19 Spanish ICU Network, Pablo Monedero, Alfredo Gea, Pedro Castro, Ángel M. Candela-Toha, Marina Vendrell, G. Sánchez‐Etayo, Amalia Alcón, Isabel Belda, Mercé Agustí, Albert Carramiñana, Isabel Gracia, Miriam Panzeri, Irene León, Jaume Balust, Ricard Navarro, M.J. Arguís, María José Carretero, Cristina Ibáñez, Juan Perdomo, Antonio Rezusta López, Manuel López-Baamonde, Tomás Cuñat, Marta Ubré, Antonio Ojeda, Andrea Calvo, Eva Rivas, Paola Hurtado, Roger Pujol, Nuria Hinarejos Martín, J. Tercero, Pepe Sanahuja, Marta Magaldi, Miquel Coca-Martínez, Elena del Río, Julia Martínez-Ocón, Paula Masgoret, Monserrat Tió, A. Caballero, Raquel Risco, R. Bergé, Lidia Díaz Gómez, Nicolás de Riva, Ana Ruiz, Beatriz, Tena, Sebastián Jaramillo, José M. Balibrea, Francisco B. de Lacy, Ana Otero, Ainitze Ibarzábal, Raquel Bravo, Anna Carreras-Castañer, Daniel Martín-Barreda, Alfonso Alías, Mariano Balaguer‐Castro, Jorge Aliaga, Alex Almuedo-Riera, Joan Ramón Alonso, Rut Andrea, Gerard Sergi Angelès, Marilyn Arias, Fátima Aziz, Joan R. Badia, Enric Barbeta, Toni Torres, Guillem Batiste, Pau Benet, X. Borrat, María Borrell, Ernest Bragulat, Inmaculada Carmona, Manuel Castellà, Pedro Castro, Joan Ceravalls, Óscar Comino, Claudia Cucciniello, Clàudia De Deray, O De Diego, Paula De la Matta, Marta Farrero, Javier Fernández, Sara Fernández, Anna Fernández, Miquel Ferrer, Ana Fervienza, María Tallo Forga, Daniel Forné, C Redondo Galán, Andrea Gómez, Eduard Guasch, María Hernández-Tejero
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.