Journal Article

Impact of early corticosteroids on 60-day mortality in critically ill patients with COVID-19: A multicenter cohort study of the OUTCOMEREA network

Reignier, Jean, Domitile, Julien, Siami, Shidasp, Gainnier, Marc, Neuville, Mathilde, Bailly, Sebastien, Goldgran-Toledano, Dany, de Montmollin, Etienne, Ruckly, Stéphane, Souweine, Bertrand, Dupuis, Claire, Alberti, Corinne, Buetti, Niccolò, Timsit, Jean-François, Schwebel, Carole, Mourvillier, Bruno, Ursino, Moreno, Laurent, Virginie

2021

Overview

In severe COVID-19 pneumonia, the appropriate timing and dosing of corticosteroids (CS) is not known. Patient subgroups for which CS could be more beneficial also need appraisal. The aim of this study was to assess the effect of early CS in COVID-19 pneumonia patients admitted to the ICU on the occurrence of 60-day mortality, ICU-acquired-bloodstream infections(ICU-BSI), and hospital-acquired pneumonia and ventilator-associated pneumonia(HAP-VAP). We included patients with COVID-19 pneumonia admitted to 11 ICUs belonging to the French OutcomeRea.sup.TM network from January to May 2020. We used survival models with ponderation with inverse probability of treatment weighting (IPTW). The study population comprised 303 patients having a median age of 61.6 (53-70) years of whom 78.8% were male and 58.6% had at least one comorbidity. The median SAPS II was 33 (25-44). Invasive mechanical ventilation was required in 34.8% of the patients. Sixty-six (21.8%) patients were in the Early-C subgroup. Overall, 60-day mortality was 29.4%. The risks of 60-day mortality (.sub.IPTW HR = 0.86;95% CI 0.54 to 1.35, p = 0.51), ICU-BSI and HAP-VAP were similar in the two groups. Importantly, early CS treatment was associated with a lower mortality rate in patients aged 60 years or more (.sub.IPTW HR, 0.53;95% CI, 0.3-0.93; p = 0.03). In contrast, CS was associated with an increased risk of death in patients younger than 60 years without inflammation on admission (.sub.IPTW HR = 5.01;95% CI, 1.05, 23.88; p = 0.04). For patients with COVID-19 pneumonia, early CS treatment was not associated with patient survival. Interestingly, inflammation and age can significantly influence the effect of CS.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adrenal Cortex Hormones / administration & dosage / Adult / Aged / Bernard, Claude (1813-1878) / Biology and Life Sciences / Care and treatment / Cohort analysis / Cohort Studies / Community Networks / Complications and side effects / Conditioned stimulus / Coronaviruses / Corticoids / Corticosteroids / COVID-19 / COVID-19 / mortality / COVID-19 Drug Treatment / Critical Illness / therapy / Critically ill / Data collection / Dosage / Drug Administration Schedule / Early Medical Intervention / methods / Evaluation / France / France / epidemiology / Health risks / Hospital Mortality / Hospitals / Immunomodulators / Infectious diseases / Inflammation / Intensive care / Intensive Care Units / statistics & numerical data / Length of stay / Life Sciences / Mechanical ventilation / Medicine and Health Sciences / Middle Aged / Middle East respiratory syndrome / Mortality / Patient outcomes / Patients / Physical Sciences / Pneumonia / Population studies / Respiration, Artificial / mortality / Respiration, Artificial / statistics & numerical data / Respiratory diseases / Sepsis / Severe acute respiratory syndrome coronavirus 2 / Subgroups / Supervision / Survival / Time Factors / Treatment Outcome / Ventilation / Ventilator-associated pneumonia