Clinical Epidemiology and Ageing

High-Dose Steroids for Nonresolving Acute Respiratory Distress Syndrome in Critically Ill COVID-19 Patients Treated With Dexamethasone: A Multicenter Cohort Study.

Lopinto J, Arrestier R, Peiffer B, Gaillet A, Voiriot G, Urbina T, Luyt C-E, Bellaïche R, Pham T, Ait-Hamou Z, Roux D, Clere-Jehl R, Azoulay E, Gaudry S, Mayaux J, Dessap AMekontso, Canoui-Poitrine F, de Prost N Crit Care Med. 2023;51(10):1306-1317.

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).


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 [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).

CONCLUSIONS: In critically ill COVID-19 patients with nonresolving ARDS, HDCT result in a higher 90-day mortality.

MeSH terms: Adrenal Cortex Hormones; COVID-19; COVID-19 Drug Treatment; Critical Illness; Dexamethasone; Humans; Methylprednisolone; Pneumonia, Ventilator-Associated; Prospective Studies; Respiratory Distress Syndrome; SARS-CoV-2
DOI: 10.1097/CCM.0000000000005930