Open AccessImpact of early corticosteroids on 60-day mortality in critically ill patients with COVID-19: A multicenter cohort study of the OUTCOMEREA network
Author(s) -
Claire Dupuis,
Étienne de Montmollin,
Niccolò Buetti,
Dany GoldgranToledano,
Jean Reignier,
Carole Schwebel,
Julien Domitile,
Mathilde Neuville,
Moreno Ursino,
Shidasp Siami,
Stéphane Ruckly,
Corinne Alberti,
Bruno Mourvillier,
Sébastien Bailly,
Virginie Laurent,
Marc Gainnier,
Bertrand Souweine,
JeanFrançois Timsit
Publication year - 2021
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0255644
Subject(s) - medicine , pneumonia , mechanical ventilation , comorbidity , mortality rate , covid-19 , saps ii , population , cohort study , cohort , intensive care medicine , pediatrics , apache ii , intensive care unit , disease , environmental health , infectious disease (medical specialty)
Objectives 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). Methods We included patients with COVID-19 pneumonia admitted to 11 ICUs belonging to the French OutcomeRea TM network from January to May 2020. We used survival models with ponderation with inverse probability of treatment weighting (IPTW). Results 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 ( 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 ( 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 ( IPTW HR = 5.01;95% CI, 1.05, 23.88; p = 0.04). Conclusion 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.