High-Dose Steroids for Nonresolving Acute Respiratory Distress Syndrome in Critically Ill COVID-19 Patients Treated With Dexamethasone: A Multicenter Cohort Study.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 10 2023
01 10 2023
Historique:
medline:
15
9
2023
pubmed:
18
5
2023
entrez:
18
5
2023
Statut:
ppublish
Résumé
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. 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. We included consecutive patients admitted in 11 ICUs of Great Paris area from September 2020 to February 2021. Three hundred eighty-three patients were included (59 in the HDCT group, 324 in the no HDCT group). None. 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 [HR], 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). In critically ill COVID-19 patients with nonresolving ARDS, HDCT result in a higher 90-day mortality.
Identifiants
pubmed: 37199534
doi: 10.1097/CCM.0000000000005930
pii: 00003246-990000000-00151
doi:
Substances chimiques
Methylprednisolone
X4W7ZR7023
Adrenal Cortex Hormones
0
Dexamethasone
7S5I7G3JQL
Types de publication
Observational Study
Multicenter Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1306-1317Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
Dr. Lopinto’s institution received funding from the Agence Nationale de la Recherche (Résilience COVID-19: ANR-21-COVR-0022). Dr. Peiffer disclosed work for hire. Dr. Luyt received funding from Merck, AdvanzPharma, and Aerogen. Dr. Azoulay’s institution received funding from MSD and Gilead; he received funding from Pfizer, Alexion, and Sanofi. Dr. de Prost received support for article research from the Agence Nationale de la Recherche (Résilience COVID-19: ANR-21-COVR-0022). The remaining authors have disclosed that they do not have any potential conflicts of interest.
Références
Yang X, Yu Y, Xu J, et al.: Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir Med 2020; 8:475–481
Cummings MJ, Baldwin MR, Abrams D, et al.: Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: A prospective cohort study. Lancet 2020; 395:1763–1770
Grasselli G, Zangrillo A, Zanella A, et al.; COVID-19 Lombardy ICU Network: Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA 2020; 323:1574–1581
Moore JB, June CH: Cytokine release syndrome in severe COVID-19. Science 2020; 368:473–474
Hue S, Beldi-Ferchiou A, Bendib I, et al.: Uncontrolled innate and impaired adaptive immune responses in patients with COVID-19 acute respiratory distress syndrome. Am J Respir Crit Care Med 2020; 202:1509–1519
Horby P, Lim WS, Emberson JR, et al.; RECOVERY Collaborative Group: Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 2021; 384:693–704
Sterne JAC, Murthy S, Diaz JV, et al.; WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group: Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: A meta-analysis. JAMA 2020; 324:1330–1341
Alhazzani W, Evans L, Alshamsi F, et al.: Surviving sepsis campaign guidelines on the management of adults with coronavirus disease 2019 (COVID-19) in the ICU: First update. Crit Care Med 2021; 49:e219–e234
Thille AW, Esteban A, Fernández-Segoviano P, et al.: Chronology of histological lesions in acute respiratory distress syndrome with diffuse alveolar damage: A prospective cohort study of clinical autopsies. Lancet Respir Med 2013; 1:395–401
Steinberg KP, Milberg JA, Martin TR, et al.: Evolution of bronchoalveolar cell populations in the adult respiratory distress syndrome. Am J Respir Crit Care Med 1994; 150:113–122
Meduri GU, Headley AS, Golden E, et al.: Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: A randomized controlled trial. JAMA 1998; 280:159–165
Steinberg KP, Hudson LD, Goodman RB, et al.; National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network: Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med 2006; 354:1671–1684
Meduri GU, Marik PE, Chrousos GP, et al.: Steroid treatment in ARDS: A critical appraisal of the ARDS network trial and the recent literature. Intensive Care Med 2008; 34:61–69
Annane D, Sébille V, Bellissant E: Effect of low doses of corticosteroids in septic shock patients with or without early acute respiratory distress syndrome*. Crit Care Med 2006; 34:22–30
Mesland JB, Carlier E, François B, et al.; On Behalf Of The Covcorvap Collaboration Group: Early corticosteroid therapy may increase ventilator-associated lower respiratory tract infection in critically ill patients with COVID-19: A multicenter retrospective cohort study. Microorganisms 2022; 10:984
Tomazini BM, Maia IS, Cavalcanti AB, et al.; COALITION COVID-19 Brazil III Investigators: Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: The CoDEX randomized clinical trial. JAMA 2020; 324:1307–1316
Rouzé A, Martin-Loeches I, Povoa P, et al.; coVAPid study Group: Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: A European multicenter cohort study. Intensive Care Med 2021; 47:188–198
Saura O, Rouzé A, Martin-Loeches I, et al.: Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: A retrospective multicenter study. Critical Care 2022; 26:292
Arrestier R, Bastard P, Belmondo T, et al.: Auto-antibodies against type I IFNs in > 10% of critically ill COVID-19 patients: A prospective multicentre study. Ann Intensive Care 2022; 12:121
Ranieri VM, Rubenfeld GD, Thompson BT, et al.; ARDS Definition Task Force: Acute respiratory distress syndrome: The Berlin definition. JAMA 2012; 307:2526–2533
Le Gall JR, Lemeshow S, Saulnier F: A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993; 270:2957–2963
Vincent JL, Moreno R, Takala J, et al.: The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996; 22:707–710
Juma S, Taabazuing MM, Montero-Odasso M: Clinical frailty scale in an acute medicine unit: A simple tool that predicts length of stay. Can Geriatr J 2016; 19:34–39
Khwaja A: KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012; 120:c179–c184
Kalil AC, Metersky ML, Klompas M, et al.: Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63:e61–e111
Martin-Loeches I, Povoa P, Rodríguez A, et al.; TAVeM study: Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): A multicentre, prospective, observational study. Lancet Respir Med. 2015; 3:859–868
Koehler P, Bassetti M, Chakrabarti A, et al.; European Confederation of Medical Mycology: Defining and managing COVID-19-associated pulmonary aspergillosis: The 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis 2021; 21:e149–e162
Thomas LE, Li F, Pencina MJ: Overlap weighting: A propensity score method that mimics attributes of a randomized clinical trial. JAMA 2020; 323:2417–2418
Mongardon N, Piagnerelli M, Grimaldi D, et al.; COVADIS study group investigators: COVADIS study group investigators. Impact of late administration of corticosteroids in COVID-19 ARDS. Intensive Care Med 2021; 47:110–112
Nseir S, Martin-Loeches I, Povoa P, et al.; coVAPid study group: Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: A planned ancillary analysis of the coVAPid cohort. Crit Care 2021; 25:177
Gragueb-Chatti I, Lopez A, Hamidi D, et al.: Impact of dexamethasone on the incidence of ventilator-associated pneumonia and blood stream infections in COVID-19 patients requiring invasive mechanical ventilation: A multicenter retrospective study. Ann Intensive Care 2021; 11:87
Rouzé A, Lemaitre E, Martin-Loeches I, et al.; coVAPid study group: Invasive pulmonary aspergillosis among intubated patients with SARS-CoV-2 or influenza pneumonia: A European multicenter comparative cohort study. Crit Care 2022; 26:11
Razazi K, Arrestier R, Haudebourg AF, et al.: Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to coronavirus 19 disease. Crit Care 2020; 24:699
Meersseman W, Lagrou K, Maertens J, et al.: Invasive aspergillosis in the intensive care unit. Clin Infect Dis 2007; 45:205–216
de Prost N, Audureau E, Heming N, et al.: Clinical phenotypes and outcomes associated with SARS-CoV-2 variant Omicron in critically ill French patients with COVID-19. Nat Commun 2022; 13:6025