Early corticosteroids are associated with lower mortality in critically ill patients with COVID-19: a cohort study

Crit Care. 2021 Jan 4;25(1):2. doi: 10.1186/s13054-020-03422-3.

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.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Aged
  • COVID-19 / mortality
  • COVID-19 Drug Treatment*
  • Critical Care / methods*
  • Critical Illness
  • Female
  • Hospital Mortality / trends*
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Prospective Studies
  • Spain / epidemiology
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones