• G Moreno, M Ruiz-Botella, I Martín-Loeches, J Gómez Álvarez, M Jiménez Herrera, M Bodí, F Armestar, A Marques Parra, Á Estella, S Trefler, R Jorge García, J Murcia Paya, P Vidal Cortes, E Díaz, R Ferrer, A Albaya-Moreno, L Socias-Crespi, J M Bonell Goytisolo, S Sancho Chinesta, A Loza, L Forcelledo Espina, J C Pozo Laderas, M deAlba-Aparicio, L Sánchez Montori, I Vallverdú Perapoch, V Hidalgo, V Fraile Gutiérrez, A M Casamitjana Ortega, F Martín Serrano, M Nieto, M Blasco Cortes, J Marín-Corral, J Solé-Violán, A Rodríguez, and on behalf COVID-19 SEMICYUC Working Group.
• ICU, Hospital Universitario Joan XXIII/URV/IISPV, Tarragona, Spain.
• Med Intensiva. 2023 Jan 1; 47 (1): 233323-33.

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.© 2021 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

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