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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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.
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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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