Early corticosteroids are associated with lower mortality in critically ill patients with COVID-19: a cohort study
- PMID: 33397463
- PMCID: PMC7780210
- DOI: 10.1186/s13054-020-03422-3
Early corticosteroids are associated with lower mortality in critically ill patients with COVID-19: a cohort study
Erratum in
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Publisher Correction: Early corticosteroids are associated with lower mortality in critically ill patients with COVID‑19: a cohort study.Crit Care. 2023 Dec 11;27(1):489. doi: 10.1186/s13054-023-04711-3. Crit Care. 2023. PMID: 38082295 Free PMC article. No abstract available.
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.
Keywords: COVID-19; Cohort study; Corticosteroids; Critically ill patient; Intensive Care Unit; Mortality; Outcomes; Ventilator-free days.
Conflict of interest statement
We declare no competing interests.
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References
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- WHO. Clinical management of COVID-19. https://www.who.int/publications/i/item/clinical-management-of-covid-19. Accessed 8 November 2020.
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- Hodgens A, Sharman T. Corticosteroids. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 14, 2020.
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- RECOVERY Collaborative Group, Horby P, Lim WS, et al. Dexamethasone in Hospitalized Patients with Covid-19-preliminary report. N Engl J Med. 2020 Jul 17:NEJMoa2021436.
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