• Antoni Torres, Ana Motos, Catia Cillóniz, Adrián Ceccato, Laia Fernández-Barat, Albert Gabarrús, Jesús Bermejo-Martin, Ricard Ferrer, Jordi Riera, Raquel Pérez-Arnal, Dario García-Gasulla, Oscar Peñuelas, José Ángel Lorente, David de Gonzalo-Calvo, Raquel Almansa, Rosario Menéndez, Andrea Palomeque, VillarRosario AmayaRAIntensive Care Clinical Unit, Hospital Universitario Virgen de Rocío, Seville, Spain., José M Añón, Ana Balan Mariño, Carme Barberà, José Barberán, Aaron Blandino Ortiz, Maria Victoria Boado, Elena Bustamante-Munguira, Jesús Caballero, María Luisa Cantón-Bulnes, Cristina Carbajales Pérez, Nieves Carbonell, Mercedes Catalán-González, Raul de Frutos, Nieves Franco, Cristóbal Galbán, Víctor D Gumucio-Sanguino, Maria Del Carmen de la Torre, Emili Díaz, Ángel Estella, Elena Gallego, José Luis García Garmendia, José M Gómez, Arturo Huerta, GarcíaRuth Noemí JorgeRNJIntensive Care Department, Hospital Nuestra Señora de Gracia, Saragossa, Spain., Ana Loza-Vázquez, Judith Marin-Corral, María Cruz Martin Delgado, Amalia Martínez de la Gándara, Ignacio Martínez Varela, Juan López Messa, Guillermo M Albaiceta, Maite Nieto, Mariana Andrea Novo, Yhivian Peñasco, Felipe Pérez-García, Juan Carlos Pozo-Laderas, Pilar Ricart, Victor Sagredo, Angel Sánchez-Miralles, Susana Sancho Chinesta, Mireia Serra-Fortuny, Lorenzo Socias, Jordi Solé-Violan, Fernando Suarez-Sipmann, Luis Tamayo Lomas, José Trenado, Alejandro Úbeda, Luis Jorge Valdivia, Pablo Vidal, Ferran Barbé, and CIBERESUCICOVID Project Investigators.
• CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. atorres@clinic.cat.
• Intensive Care Med. 2022 Jul 1; 48 (7): 850864850-864.

PurposeAlthough there is evidence supporting the benefits of corticosteroids in patients affected with severe coronavirus disease 2019 (COVID-19), there is little information related to their potential benefits or harm in some subgroups of patients admitted to the intensive care unit (ICU) with COVID-19. We aim to investigate to find candidate variables to guide personalized treatment with steroids in critically ill patients with COVID-19.MethodsMulticentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs. The primary outcome was 90-day mortality. Subsequent analyses in clinically relevant subgroups by age, ICU baseline illness severity, organ damage, laboratory findings and mechanical ventilation were performed. High doses of corticosteroids (≥ 12 mg/day equivalent dexamethasone dose), early administration of corticosteroid treatment (< 7 days since symptom onset) and long term of corticosteroids (≥ 10 days) were also investigated.ResultsBetween February 2020 and October 2021, 4226 patients were included. Of these, 3592 (85%) patients had received systemic corticosteroids during hospitalisation. In the propensity-adjusted multivariable analysis, the use of corticosteroids was protective for 90-day mortality in the overall population (HR 0.77 [0.65-0.92], p = 0.003) and in-hospital mortality (SHR 0.70 [0.58-0.84], p < 0.001). Significant effect modification was found after adjustment for covariates using propensity score for age (p = 0.001 interaction term), Sequential Organ Failure Assessment (SOFA) score (p = 0.014 interaction term), and mechanical ventilation (p = 0.001 interaction term). We observed a beneficial effect of corticosteroids on 90-day mortality in various patient subgroups, including those patients aged ≥ 60 years; those with higher baseline severity; and those receiving invasive mechanical ventilation at ICU admission. Early administration was associated with a higher risk of 90-day mortality in the overall population (HR 1.32 [1.14-1.53], p < 0.001). Long-term use was associated with a lower risk of 90-day mortality in the overall population (HR 0.71 [0.61-0.82], p < 0.001). No effect was found regarding the dosage of corticosteroids. Moreover, the use of corticosteroids was associated with an increased risk of nosocomial bacterial pneumonia and hyperglycaemia.ConclusionCorticosteroid in ICU-admitted patients with COVID-19 may be administered based on age, severity, baseline inflammation, and invasive mechanical ventilation. Early administration since symptom onset may prove harmful.© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.

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