tetano
Editor, Senior Moderator
Crit Care Med
. 2023 May 18.
doi: 10.1097/CCM.0000000000005930. Online ahead of print. High-Dose Steroids for Nonresolving Acute Respiratory Distress Syndrome in Critically Ill COVID-19 Patients Treated With Dexamethasone: A Multicenter Cohort Study
Julien Lopinto[SUP] 1 2 [/SUP], Romain Arrestier[SUP] 1 2 [/SUP], Bastien Peiffer[SUP] 3 [/SUP], Antoine Gaillet[SUP] 1 2 [/SUP], Guillaume Voiriot[SUP] 4 [/SUP], Tomas Urbina[SUP] 5 [/SUP], Charles-Edouard Luyt[SUP] 6 7 [/SUP], Raphaël Bellaïche[SUP] 8 [/SUP], Tái Pham[SUP] 9 [/SUP], Zakaria Ait-Hamou[SUP] 10 [/SUP], Damien Roux[SUP] 11 12 [/SUP], Raphaël Clere-Jehl[SUP] 13 [/SUP], Elie Azoulay[SUP] 13 [/SUP], Stéphane Gaudry[SUP] 14 [/SUP], Julien Mayaux[SUP] 15 [/SUP], Armand Mekontso Dessap[SUP] 1 2 [/SUP], Florence Canoui-Poitrine[SUP] 3 [/SUP], Nicolas de Prost[SUP] 1 2 [/SUP]
Affiliations
Objectives: To determine the impact of high doses of corticosteroids (HDCT) in critically ill COVID-19 patients with nonresolving acute respiratory distress syndrome (ARDS) who had been previously treated with dexamethasone as a standard of care.
Design: Prospective observational cohort study. Eligible patients presented nonresolving ARDS related to severe acute respiratory syndrome coronavirus 2 infection and had received initial treatment with dexamethasone. We compared patients who had received or not HDCT during ICU stay, consisting of greater than or equal to 1 mg/kg of methylprednisolone or equivalent for treatment of nonresolving ARDS. The primary outcome was 90-day mortality. We assessed the impact of HDCT on 90-day mortality using univariable and multivariable Cox regression analysis. Further adjustment for confounding variables was performed using overlap weighting propensity score. The association between HDCT and the risk of ventilator-associated pneumonia was estimated using multivariable cause-specific Cox proportional hazard model adjusting for pre-specified confounders.
Setting: We included consecutive patients admitted in 11 ICUs of Great Paris area from September 2020 to February 2021.
Patients: Three hundred eighty-three patients were included (59 in the HDCT group, 324 in the no HDCT group).
Interventions: None.
Measurements and main results: At day 90, 30 of 59 patients (51%) in the HDCT group and 116 of 324 patients (35.8%) in the no HDCT group had died. HDCT was significantly associated with 90-day mortality in unadjusted (hazard ratio
, 1.60; 95% CI, 1.04-2.47; p = 0.033) and adjusted analysis with overlap weighting (adjusted HR, 1.65; 95% CI, 1.03-2.63; p = 0.036). HDCT was not associated with an increased risk of ventilator-associated pneumonia (adjusted cause-specific HR, 0.42; 95% CI, 0.15-1.16; p = 0.09).
Conclusions: In critically ill COVID-19 patients with nonresolving ARDS, HDCT result in a higher 90-day mortality.
. 2023 May 18.
doi: 10.1097/CCM.0000000000005930. Online ahead of print. High-Dose Steroids for Nonresolving Acute Respiratory Distress Syndrome in Critically Ill COVID-19 Patients Treated With Dexamethasone: A Multicenter Cohort Study
Julien Lopinto[SUP] 1 2 [/SUP], Romain Arrestier[SUP] 1 2 [/SUP], Bastien Peiffer[SUP] 3 [/SUP], Antoine Gaillet[SUP] 1 2 [/SUP], Guillaume Voiriot[SUP] 4 [/SUP], Tomas Urbina[SUP] 5 [/SUP], Charles-Edouard Luyt[SUP] 6 7 [/SUP], Raphaël Bellaïche[SUP] 8 [/SUP], Tái Pham[SUP] 9 [/SUP], Zakaria Ait-Hamou[SUP] 10 [/SUP], Damien Roux[SUP] 11 12 [/SUP], Raphaël Clere-Jehl[SUP] 13 [/SUP], Elie Azoulay[SUP] 13 [/SUP], Stéphane Gaudry[SUP] 14 [/SUP], Julien Mayaux[SUP] 15 [/SUP], Armand Mekontso Dessap[SUP] 1 2 [/SUP], Florence Canoui-Poitrine[SUP] 3 [/SUP], Nicolas de Prost[SUP] 1 2 [/SUP]
Affiliations
- PMID: 37199534
- DOI: 10.1097/CCM.0000000000005930
Objectives: To determine the impact of high doses of corticosteroids (HDCT) in critically ill COVID-19 patients with nonresolving acute respiratory distress syndrome (ARDS) who had been previously treated with dexamethasone as a standard of care.
Design: Prospective observational cohort study. Eligible patients presented nonresolving ARDS related to severe acute respiratory syndrome coronavirus 2 infection and had received initial treatment with dexamethasone. We compared patients who had received or not HDCT during ICU stay, consisting of greater than or equal to 1 mg/kg of methylprednisolone or equivalent for treatment of nonresolving ARDS. The primary outcome was 90-day mortality. We assessed the impact of HDCT on 90-day mortality using univariable and multivariable Cox regression analysis. Further adjustment for confounding variables was performed using overlap weighting propensity score. The association between HDCT and the risk of ventilator-associated pneumonia was estimated using multivariable cause-specific Cox proportional hazard model adjusting for pre-specified confounders.
Setting: We included consecutive patients admitted in 11 ICUs of Great Paris area from September 2020 to February 2021.
Patients: Three hundred eighty-three patients were included (59 in the HDCT group, 324 in the no HDCT group).
Interventions: None.
Measurements and main results: At day 90, 30 of 59 patients (51%) in the HDCT group and 116 of 324 patients (35.8%) in the no HDCT group had died. HDCT was significantly associated with 90-day mortality in unadjusted (hazard ratio
, 1.60; 95% CI, 1.04-2.47; p = 0.033) and adjusted analysis with overlap weighting (adjusted HR, 1.65; 95% CI, 1.03-2.63; p = 0.036). HDCT was not associated with an increased risk of ventilator-associated pneumonia (adjusted cause-specific HR, 0.42; 95% CI, 0.15-1.16; p = 0.09).
Conclusions: In critically ill COVID-19 patients with nonresolving ARDS, HDCT result in a higher 90-day mortality.