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Outcome of Critically Ill COVID-19 Patients According to the Setting of Corticosteroid Initiation—A Retrospective Observational Cohort Study
(1) Background: Corticosteroids lower 28-day all-cause mortality in critically ill COVID-19 patients. However, the outcome of COVID-19 patients referred to the intensive care unit (ICU) for respiratory deterioration despite corticosteroids initiated during hospitalization before ICU admission has be...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8706060/ https://www.ncbi.nlm.nih.gov/pubmed/34945831 http://dx.doi.org/10.3390/jpm11121359 |
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author | Voicu, Sebastian Lacoste-Palasset, Thomas Malissin, Isabelle Bekhit, Shana Cauchois, Eléonore Dahmani, Sirine Saib, Melkir Grant, Caroline Naim, Giulia M’Rad, Aymen Pepin-Lehaleur, Adrien Ekhérian, Jean-Michel Deye, Nicolas Mégarbane, Bruno |
author_facet | Voicu, Sebastian Lacoste-Palasset, Thomas Malissin, Isabelle Bekhit, Shana Cauchois, Eléonore Dahmani, Sirine Saib, Melkir Grant, Caroline Naim, Giulia M’Rad, Aymen Pepin-Lehaleur, Adrien Ekhérian, Jean-Michel Deye, Nicolas Mégarbane, Bruno |
author_sort | Voicu, Sebastian |
collection | PubMed |
description | (1) Background: Corticosteroids lower 28-day all-cause mortality in critically ill COVID-19 patients. However, the outcome of COVID-19 patients referred to the intensive care unit (ICU) for respiratory deterioration despite corticosteroids initiated during hospitalization before ICU admission has been poorly investigated. Our objective was to determine survival according to corticosteroid initiation setting. (2) Methods: We conducted a cohort study including all successive critically ill COVID-19 patients treated with corticosteroids and managed in our ICU. We compared survival, whether corticosteroids were initiated before (Cb-group) or after ICU admission (Ca-group), using a propensity score matching. (3) Results: Overall, 228 patients (67 years (56–74); 168M/60F; invasive mechanical ventilation on admission, 17%) were included with 63 patients in the Cb-group and 165 patients in the Ca-group. Survival to hospital discharge was 43% versus 69%, respectively (p = 0.001). In a multivariable analysis, factors associated with death were age (odds ratio, 1.07; 95%-confidence interval, (1.04–1.11); p < 0.0001), the sequential organ failure assessment (SOFA) score on ICU admission (1.30 (1.14–1.50); p = 0.0001) and corticosteroid initiation before ICU admission (2.64 (1.30–5.43); p = 0.007). No significant differences in outcome related to corticosteroid regimen were found. (4) Conclusions: Critically ill COVID-19 patients transferred to the ICU with deterioration despite corticosteroids initiated before admission have a less favorable outcome than patients receiving corticosteroids initiated after ICU admission. |
format | Online Article Text |
id | pubmed-8706060 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-87060602021-12-25 Outcome of Critically Ill COVID-19 Patients According to the Setting of Corticosteroid Initiation—A Retrospective Observational Cohort Study Voicu, Sebastian Lacoste-Palasset, Thomas Malissin, Isabelle Bekhit, Shana Cauchois, Eléonore Dahmani, Sirine Saib, Melkir Grant, Caroline Naim, Giulia M’Rad, Aymen Pepin-Lehaleur, Adrien Ekhérian, Jean-Michel Deye, Nicolas Mégarbane, Bruno J Pers Med Article (1) Background: Corticosteroids lower 28-day all-cause mortality in critically ill COVID-19 patients. However, the outcome of COVID-19 patients referred to the intensive care unit (ICU) for respiratory deterioration despite corticosteroids initiated during hospitalization before ICU admission has been poorly investigated. Our objective was to determine survival according to corticosteroid initiation setting. (2) Methods: We conducted a cohort study including all successive critically ill COVID-19 patients treated with corticosteroids and managed in our ICU. We compared survival, whether corticosteroids were initiated before (Cb-group) or after ICU admission (Ca-group), using a propensity score matching. (3) Results: Overall, 228 patients (67 years (56–74); 168M/60F; invasive mechanical ventilation on admission, 17%) were included with 63 patients in the Cb-group and 165 patients in the Ca-group. Survival to hospital discharge was 43% versus 69%, respectively (p = 0.001). In a multivariable analysis, factors associated with death were age (odds ratio, 1.07; 95%-confidence interval, (1.04–1.11); p < 0.0001), the sequential organ failure assessment (SOFA) score on ICU admission (1.30 (1.14–1.50); p = 0.0001) and corticosteroid initiation before ICU admission (2.64 (1.30–5.43); p = 0.007). No significant differences in outcome related to corticosteroid regimen were found. (4) Conclusions: Critically ill COVID-19 patients transferred to the ICU with deterioration despite corticosteroids initiated before admission have a less favorable outcome than patients receiving corticosteroids initiated after ICU admission. MDPI 2021-12-13 /pmc/articles/PMC8706060/ /pubmed/34945831 http://dx.doi.org/10.3390/jpm11121359 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Voicu, Sebastian Lacoste-Palasset, Thomas Malissin, Isabelle Bekhit, Shana Cauchois, Eléonore Dahmani, Sirine Saib, Melkir Grant, Caroline Naim, Giulia M’Rad, Aymen Pepin-Lehaleur, Adrien Ekhérian, Jean-Michel Deye, Nicolas Mégarbane, Bruno Outcome of Critically Ill COVID-19 Patients According to the Setting of Corticosteroid Initiation—A Retrospective Observational Cohort Study |
title | Outcome of Critically Ill COVID-19 Patients According to the Setting of Corticosteroid Initiation—A Retrospective Observational Cohort Study |
title_full | Outcome of Critically Ill COVID-19 Patients According to the Setting of Corticosteroid Initiation—A Retrospective Observational Cohort Study |
title_fullStr | Outcome of Critically Ill COVID-19 Patients According to the Setting of Corticosteroid Initiation—A Retrospective Observational Cohort Study |
title_full_unstemmed | Outcome of Critically Ill COVID-19 Patients According to the Setting of Corticosteroid Initiation—A Retrospective Observational Cohort Study |
title_short | Outcome of Critically Ill COVID-19 Patients According to the Setting of Corticosteroid Initiation—A Retrospective Observational Cohort Study |
title_sort | outcome of critically ill covid-19 patients according to the setting of corticosteroid initiation—a retrospective observational cohort study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8706060/ https://www.ncbi.nlm.nih.gov/pubmed/34945831 http://dx.doi.org/10.3390/jpm11121359 |
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