TY - JOUR T1 - A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients JO - Medicina Intensiva (English Edition) T2 - AU - Moreno,G. AU - Ruiz-Botella,M. AU - Martín-Loeches,I. AU - Gómez Álvarez,J. AU - Jiménez Herrera,M. AU - Bodí,M. AU - Armestar,F. AU - Marques Parra,A. AU - Estella,Á. AU - Trefler,S. AU - Jorge García,R. AU - Murcia Paya,J. AU - Vidal Cortes,P. AU - Díaz,E. AU - Ferrer,R. AU - Albaya-Moreno,A. AU - Socias-Crespi,L. AU - Bonell Goytisolo,J.M. AU - Sancho Chinesta,S. AU - Loza,A. AU - Forcelledo Espina,L. AU - Pozo Laderas,J.C. AU - deAlba-Aparicio,M. AU - Sánchez Montori,L. AU - Vallverdú Perapoch,I. AU - Hidalgo,V. AU - Fraile Gutiérrez,V. AU - Casamitjana Ortega,A.M. AU - Martín Serrano,F. AU - Nieto,M. AU - Blasco Cortes,M. AU - Marín-Corral,J. AU - Solé-Violán,J. AU - Rodríguez,A. SN - 02105691 M3 - 10.1016/j.medin.2021.10.002 DO - 10.1016/j.medin.2021.10.002 UR - https://www.medintensiva.org/es-a-differential-therapeutic-consideration-for-articulo-S0210569121002175 AB - ObjectiveTo determine if the use of corticosteroids was associated with Intensive Care Unit (ICU) mortality among whole population and pre-specified clinical phenotypes. DesignA secondary analysis derived from multicenter, observational study. SettingCritical Care Units. PatientsAdult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain. InterventionsCorticosteroids vs. no corticosteroids. Main variables of interestThree 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. ResultsA 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. ConclusionOur 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. ER -