PDF(Pubmed)
Abstract：
To determine if the use of corticosteroids was associated with Intensive Care Unit (ICU) mortality among whole population and pre-specified clinical phenotypes.
A secondary analysis derived from multicenter, observational study.
Critical Care Units.
Adult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain.
Corticosteroids vs. no corticosteroids.
Three phenotypes were derived by non-supervised clustering analysis from whole population and classified as (A: severe, B: critical and C: life-threatening). We performed a multivariate analysis after propensity optimal full matching (PS) for whole population and weighted Cox regression (HR) and Fine-Gray analysis (sHR) to assess the impact of corticosteroids on ICU mortality according to the whole population and distinctive patient clinical phenotypes.
A total of 2017 patients were analyzed, 1171 (58%) with corticosteroids. After PS, corticosteroids were shown not to be associated with ICU mortality (OR: 1.0; 95% CI: 0.98-1.15). Corticosteroids were administered in 298/537 (55.5%) patients of \"A\" phenotype and their use was not associated with ICU mortality (HR=0.85 [0.55-1.33]). A total of 338/623 (54.2%) patients in \"B\" phenotype received corticosteroids. No effect of corticosteroids on ICU mortality was observed when HR was performed (0.72 [0.49-1.05]). Finally, 535/857 (62.4%) patients in \"C\" phenotype received corticosteroids. In this phenotype HR (0.75 [0.58-0.98]) and sHR (0.79 [0.63-0.98]) suggest a protective effect of corticosteroids on ICU mortality.
Our finding warns against the widespread use of corticosteroids in all critically ill patients with COVID-19 at moderate dose. Only patients with the highest inflammatory levels could benefit from steroid treatment.
A secondary analysis derived from multicenter, observational study.
Critical Care Units.
Adult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain.
Corticosteroids vs. no corticosteroids.
Three phenotypes were derived by non-supervised clustering analysis from whole population and classified as (A: severe, B: critical and C: life-threatening). We performed a multivariate analysis after propensity optimal full matching (PS) for whole population and weighted Cox regression (HR) and Fine-Gray analysis (sHR) to assess the impact of corticosteroids on ICU mortality according to the whole population and distinctive patient clinical phenotypes.
A total of 2017 patients were analyzed, 1171 (58%) with corticosteroids. After PS, corticosteroids were shown not to be associated with ICU mortality (OR: 1.0; 95% CI: 0.98-1.15). Corticosteroids were administered in 298/537 (55.5%) patients of \"A\" phenotype and their use was not associated with ICU mortality (HR=0.85 [0.55-1.33]). A total of 338/623 (54.2%) patients in \"B\" phenotype received corticosteroids. No effect of corticosteroids on ICU mortality was observed when HR was performed (0.72 [0.49-1.05]). Finally, 535/857 (62.4%) patients in \"C\" phenotype received corticosteroids. In this phenotype HR (0.75 [0.58-0.98]) and sHR (0.79 [0.63-0.98]) suggest a protective effect of corticosteroids on ICU mortality.
Our finding warns against the widespread use of corticosteroids in all critically ill patients with COVID-19 at moderate dose. Only patients with the highest inflammatory levels could benefit from steroid treatment.
摘要：
目的：确定使用糖皮质激素是否与整个人群和预先指定的临床表型的重症监护病房（ICU）死亡率相关。
方法：来自多中心的二级分析，观察性研究。
方法：重症监护病房。
方法：西班牙63个ICU收治的确诊为COVID-19疾病的成人危重患者。
方法：皮质类固醇与没有皮质类固醇.
方法：通过非监督聚类分析从整个人群中得出三种表型，并分类为（A：严重，B:危重C:危及生命)。我们对整个人群进行了倾向最佳完全匹配（PS）和加权Cox回归（HR）和精细灰色分析（sHR）后的多变量分析，以根据整个人群和独特的患者临床表型评估皮质类固醇对ICU死亡率的影响。
结果：共对2017年患者进行分析，1171(58%)用皮质类固醇。PS之后,研究显示皮质类固醇与ICU死亡率无相关性(OR:1.0;95%CI:0.98~1.15).298/537例（55.5%）“A”表型患者使用皮质类固醇，其使用与ICU死亡率无关（HR=0.85[0.55-1.33]）。共有338/623例（54.2%）“B”表型患者接受皮质类固醇治疗。当进行HR时，未观察到皮质类固醇对ICU死亡率的影响(0.72[0.49-1.05])。最后,535/857（62.4%）“C”表型患者接受皮质类固醇治疗。在该表型中,HR(0.75[0.58-0.98])和sHR(0.79[0.63-0.98])提示皮质类固醇对ICU死亡率具有保护作用。
结论：我们的发现警告所有中度剂量COVID-19的危重患者广泛使用皮质类固醇。只有炎症水平最高的患者才能从类固醇治疗中受益。
方法：来自多中心的二级分析，观察性研究。
方法：重症监护病房。
方法：西班牙63个ICU收治的确诊为COVID-19疾病的成人危重患者。
方法：皮质类固醇与没有皮质类固醇.
方法：通过非监督聚类分析从整个人群中得出三种表型，并分类为（A：严重，B:危重C:危及生命)。我们对整个人群进行了倾向最佳完全匹配（PS）和加权Cox回归（HR）和精细灰色分析（sHR）后的多变量分析，以根据整个人群和独特的患者临床表型评估皮质类固醇对ICU死亡率的影响。
结果：共对2017年患者进行分析，1171(58%)用皮质类固醇。PS之后,研究显示皮质类固醇与ICU死亡率无相关性(OR:1.0;95%CI:0.98~1.15).298/537例（55.5%）“A”表型患者使用皮质类固醇，其使用与ICU死亡率无关（HR=0.85[0.55-1.33]）。共有338/623例（54.2%）“B”表型患者接受皮质类固醇治疗。当进行HR时，未观察到皮质类固醇对ICU死亡率的影响(0.72[0.49-1.05])。最后,535/857（62.4%）“C”表型患者接受皮质类固醇治疗。在该表型中,HR(0.75[0.58-0.98])和sHR(0.79[0.63-0.98])提示皮质类固醇对ICU死亡率具有保护作用。
结论：我们的发现警告所有中度剂量COVID-19的危重患者广泛使用皮质类固醇。只有炎症水平最高的患者才能从类固醇治疗中受益。
