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. 2021 Aug 4;16(8):e0255644.
doi: 10.1371/journal.pone.0255644. eCollection 2021.

Impact of early corticosteroids on 60-day mortality in critically ill patients with COVID-19: A multicenter cohort study of the OUTCOMEREA network

Claire Dupuis  1   2 , Etienne de Montmollin  2   3 , Niccolò Buetti  3 , Dany Goldgran-Toledano  4 , Jean Reignier  5 , Carole Schwebel  6 , Julien Domitile  1 , Mathilde Neuville  7 , Moreno Ursino  8   9 , Shidasp Siami  10 , Stéphane Ruckly  11 , Corinne Alberti  12 , Bruno Mourvillier  13 , Sebastien Bailly  14 , Virginie Laurent  15 , Marc Gainnier  16 , Bertrand Souweine  1 , Jean-François Timsit  2   3 ; OutcomeReaTM research network
Affiliations

Impact of early corticosteroids on 60-day mortality in critically ill patients with COVID-19: A multicenter cohort study of the OUTCOMEREA network

Claire Dupuis et al. PLoS One. .

Abstract

Objectives: In severe COVID-19 pneumonia, the appropriate timing and dosing of corticosteroids (CS) is not known. Patient subgroups for which CS could be more beneficial also need appraisal. The aim of this study was to assess the effect of early CS in COVID-19 pneumonia patients admitted to the ICU on the occurrence of 60-day mortality, ICU-acquired-bloodstream infections(ICU-BSI), and hospital-acquired pneumonia and ventilator-associated pneumonia(HAP-VAP).

Methods: We included patients with COVID-19 pneumonia admitted to 11 ICUs belonging to the French OutcomeReaTM network from January to May 2020. We used survival models with ponderation with inverse probability of treatment weighting (IPTW).

Results: The study population comprised 303 patients having a median age of 61.6 (53-70) years of whom 78.8% were male and 58.6% had at least one comorbidity. The median SAPS II was 33 (25-44). Invasive mechanical ventilation was required in 34.8% of the patients. Sixty-six (21.8%) patients were in the Early-C subgroup. Overall, 60-day mortality was 29.4%. The risks of 60-day mortality (IPTWHR = 0.86;95% CI 0.54 to 1.35, p = 0.51), ICU-BSI and HAP-VAP were similar in the two groups. Importantly, early CS treatment was associated with a lower mortality rate in patients aged 60 years or more (IPTWHR, 0.53;95% CI, 0.3-0.93; p = 0.03). In contrast, CS was associated with an increased risk of death in patients younger than 60 years without inflammation on admission (IPTWHR = 5.01;95% CI, 1.05, 23.88; p = 0.04).

Conclusion: For patients with COVID-19 pneumonia, early CS treatment was not associated with patient survival. Interestingly, inflammation and age can significantly influence the effect of CS.

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Conflict of interest statement

The authors have read the journal’s policy and have the following competing interests: SR is a paid employee of ICUREsearch. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flow chart.
ICU: Intensive care unit; LOS: Length of stay; CS: Corticosteroids.
Fig 2
Fig 2. Effect of corticosteroids on ICU death and the occurrence of blood stream infection and HAP-VAP of patients in the main cohort.
HAP-VAP: hospital-acquired pneumonia and ventilator-associated pneumonia; HR: Hazard ratio; CI: Confidence interval.
Fig 3
Fig 3. Effect of corticosteroids on ICU death in different subgroups.
CS: Corticosteroids; IMV: Invasive mechanical ventilation; HR: Hazard Ratio; CI: Confidence Interval.
See this image and copyright information in PMC

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ICUREsearch provided support in the form of salary for SR. The specific roles of these authors are articulated in the ‘author contributions’ section. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.