Although tests exist that support the benefits of corticosteroids in patients with severe COVID-19, information on the potential benefits or harm in some subgroups of patients admitted to the intensive care unit (ICU) is scarce.
Antoni Torres, head of the IDIBAPS group Applied research on respiratory infections and the critical patient and a pneumologist at Hospital Clínic, and his team have found that corticosteroids are effective in improving patient survival. They must, however, be administrated based on age, severity, baseline inflammation, and invasive mechanical ventilation. Furthermore, early use of corticosteroids, 7 days or less before onset of symptoms, may be harmful to the patients.
These results, which are part of the CIBERES-UCI-COVID project, also led by Torres, are based on the analysis, between February 2020 and October 2021, of 4,226 patients admitted to 55 ICUs in Spain, most of whom (85%) were treated with systemic corticosteroids during hospitalization. The researchers specifically looked at mortality after 90 days and the impact of the age of the patients, severity of clinical symptoms, organ damage, and the use of mechanical ventilation as a respiratory support tool on the course of the disease. They also analyzed the dosages of corticosteroids administered, as well as the start day and duration of treatment. Anna Motos, of Hospital Clinic, Barcelona, and Ferrán Barbé, of Hospital Arnau de Vilanova, Lleida, coordinated the study together with Torres.
According to the result, corticosteroids were, overall, effective in reducing mortality at 90 days and intrahospital mortality. The researchers also found that the level of efficacy of the use of corticosteroids varied depending on the factors studied, which suggests the need to personalize the use of this type of drug. Specifically, corticosteroids were especially useful in three types of patients: those over 60 years of age, patients who presented greater severity of COVID-19 after admission, and patients who required mechanical ventilation in the ICU. On the other hand, the use of these drugs at an early stage was associated with a higher risk of mortality at 90 days, whereas their prolonged use (10 days or more) reduced this mortality.
The study’s authors found no effect in relation to the dosage, and indicate that corticosteroids show a significant association with a higher risk of nosocomial bacterial pneumonia and hyperglycemia. The journal Intensive Care Medicine has published the study, to which it dedicates an editorial, which takes a close look at the potential of precision medicine in therapy with corticosteroids in patients diagnosed with COVID-19.
Reference article
Torres A, Motos A, Cillóniz C, Ceccato A, Fernández-Barat L, Gabarrús A, Bermejo-Martin J, Ferrer R, Riera J, Pérez-Arnal R, García-Gasulla D, Peñuelas O, Lorente JÁ, de Gonzalo-Calvo D, Almansa R, Menéndez R, Palomeque A, Villar RA, Añón JM, Balan Mariño A, Barberà C, Barberán J, Blandino Ortiz A, Boado MV, Bustamante-Munguira E, Caballero J, Cantón-Bulnes ML, Carbajales Pérez C, Carbonell N, Catalán-González M, de Frutos R, Franco N, Galbán C, Gumucio-Sanguino VD, de la Torre MDC, Díaz E, Estella Á, Gallego E, García Garmendia JL, Gómez JM, Huerta A, García RNJ, Loza-Vázquez A, Marin-Corral J, Martin Delgado MC, Martínez de la Gándara A, Martínez Varela I, López Messa J, Albaiceta GM, Nieto M, Novo MA, Peñasco Y, Pérez-García F, Pozo-Laderas JC, Ricart P, Sagredo V, Sánchez-Miralles A, Sancho Chinesta S, Serra-Fortuny M, Socias L, Solé-Violan J, Suarez-Sipmann F, Tamayo Lomas L, Trenado J, Úbeda A, Valdivia LJ, Vidal P, Barbé F; CIBERESUCICOVID Project Investigators. Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study. Intensive Care Med. 2022 Jun 21:1–15. doi: 10.1007/s00134-022-06726-w.
