Steroid use in elderly critically ill COVID-19 patients

Jung, Christian; Wernly, Bernhard; Fjølner, Jesper; Bruno, Raphael Romano; Dudzinski, David M.; Artigas, Antonio; Pinto, Bernardo Bollen; Schefold, Joerg C.; Wolff, Georg; Kelm, Malte; Beil, Michael; Sviri, Sigal; Heerden, Peter Vernon van; Szczeklik, Wojciech; Czuczwar, Mirosław; Elhadi, Muhammed; Joannidis, Michael; Oeyen, Sandra; Zafeiridis, Tilemachos; Marsh, Brian; Andersen, Finn H.; Moreno, Rui P.; Cecconi, Maurizio; Leaver, Susannah; Boumendil, Ariane; Lange, Dylan W. de; Guidet, Bertrand

doi:10.1183/13993003.00979-2021

Cited by 47 publications

(50 citation statements)

References 8 publications

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“…Second, mortality was significantly higher in elderly patients receiving corticosteroids and corticotherapy was independently associated with increased mortality. These results are similar to previously reported data questioning the routine use of corticosteroid treatment in elderly COVID-19 patients [ 41 ]. Even though this study was not specifically designed to evaluate the effects of corticosteroids in elderly patients, the results suggest that this treatment might not be as beneficial as expected from the results in younger patients.…”

Section: Discussionsupporting

confidence: 92%

“…In this cohort, corticosteroid prescription was independently associated with mortality in the multivariate analysis (Table 3). There are some previously published data suggesting similar results, as a secondary analysis of the COVIP study having found a higher 30-day-mortality in critically ill COVID-19 patients, aged 70 years or older, who received steroids as part of their treatment [41]. However, there is no recommendation yet for the differentiated treatment of elderly patients.…”

Section: Corticosteroid Prescription In Elderly Patientsmentioning

confidence: 74%

“…We found that the impact of corticosteroids on mortality differs according to the period of COVID-19 surge, but we did not analyse the SARS-CoV-2 variants. A few researchers have already suggested that the natural history of the different SARS-CoV-2 variant diseases responded differently to corticosteroids [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of COVID-19 Critically Ill Extremely Elderly Patients: Analysis of a Large, National, Observational Cohort

Andrei

Văleanu

Ştefan

et al. 2022

JCM

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Background. During the COVID-19 pandemic, resource allocation became a major problem in globally overwhelmed ICUs. The main goal of this study was to describe the clinical characteristics of the very elderly patients (aged ≥ 80 years) with COVID-19 admitted in Romanian ICUs. The study objectives were to evaluate and determine the factors associated with ICU mortality. Methods. We designed a national, multicentric, observational platform with prospective enrolment. This study included patients aged ≥ 80 years admitted in Romanian ICUs with SARS-CoV-2 infection from March 2020 to December 2021. Results. We included 1666 patients with a median age of 83 years and 78% ICU mortality. Male sex, dyspnoea, lower Glasgow Coma Scale and lower SpO2 at ICU admission, the need for mechanical ventilation (MV), and corticosteroid use were independently associated with mortality. A total of 886/1666 (53%) elderly patients underwent invasive mechanical ventilation, with a mortality of 97%. The age impact on mortality was confirmed by a 1:1 propensity matching with less elderly ICU patients. Conclusion. In extremely elderly patients with COVID-19 admitted in the ICU, mortality is high, particularly when requiring MV. Therapy should be directed towards the optimization of less invasive ventilatory methods and the use of MV and corticosteroids only in highly selected patients.

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Section: Discussionsupporting

confidence: 92%

Section: Corticosteroid Prescription In Elderly Patientsmentioning

confidence: 74%

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Outcomes of COVID-19 Critically Ill Extremely Elderly Patients: Analysis of a Large, National, Observational Cohort

Andrei

Văleanu

Ştefan

et al. 2022

JCM

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“…Even before COVID-19, the impact of corticosteroids has been inconsistent in other causes of pneumonia including influenza, community-acquired pneumonia (CAP), and the original severe acute respiratory syndrome (SARS) [ 8 , 23 – 26 ]. The impact of corticosteroids likely depends on multiple factors, including patient age and other characteristics, heterogeneity in host response to infection, etiology of pneumonia, time since onset of infection and presence and severity of acute respiratory distress syndrome (ARDS) [ 8 , 10 , 27 – 31 ]. While corticosteroids may decrease host inflammatory response, potentially modulating lung injury, they may also have harmful side effects or unintended consequences on adaptive immune responses that may be important to resolution of infection and increase risk of secondary infection.…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone in hospitalised COVID-19 patients not on intensive respiratory support

et al. 2021

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IntroductionDexamethasone decreases mortality in coronavirus disease 2019 (COVID-19) patients on intensive respiratory support (IRS) but is of uncertain benefit if less severely ill. We determined whether early (within 48 h) dexamethasone was associated with mortality in patients hospitalised with COVID-19 not on IRS.MethodsWe included patients admitted to Veterans Affairs hospitals between June 7, 2020-May 31, 2021 within 14-days after SARS-CoV-2 positive test. Exclusions included recent prior corticosteroids and IRS within 48 h. We used inverse probability of treatment weights (IPTW) to balance exposed and unexposed groups, and Cox proportional hazards models to determine 90-day all-cause mortality.ResultsOf 19 973 total patients (95% men, median age 71, 27% black), 15 404 (77%) were without IRS within 48 h. Of these, 3514/9450 (34%) patients on no oxygen received dexamethasone and 1042 (11%) died; 4472/5954 (75%) patients on low-flow nasal cannula (NC) received dexamethasone and 857 (14%) died. In IPTW stratified models, patients on no oxygen who received dexamethasone experienced 76% increased risk for 90-day mortality (hazard ratio [HR] 1.76, 95% confidence interval [CI] 1.47 to 2.12); there was no association with mortality among patients on NC (HR 1.08, 95% CI 0.86 to 1.36).ConclusionIn patients hospitalised with COVID-19, early initiation of dexamethasone was common and was associated with no mortality benefit among those on no oxygen or NC in the first 48 h; instead, we found evidence of potential harm. These real-world findings do not support the use of early dexamethasone in hospitalised COVID-19 patients without IRS.

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“…Un patient non fragile de plus de 75 ans avait une meilleure survie à 3 mois qu’un patient fragile de moins de 75 ans [28] . L’impact des traitements corticoïdes était opposé à ce qui est rapporté chez des patients plus jeunes avec une surmortalité soulignant l’absolue nécessité d’avoir des études incluant les patients âgés [34] .…”

Section: Particularités De La Covid Chez Les Patients âGésunclassified

Réanimation et Covid

Guidet

2022

Bulletin de l'Académie Nationale de Médecine

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Steroid use in elderly critically ill COVID-19 patients

Abstract: This secondary analysis of the COVIP study shows a higher 30-day-mortality in critically ill elderly COVID-19 patients who received steroids as part of their treatment.

Cited by 47 publications

References 8 publications

Outcomes of COVID-19 Critically Ill Extremely Elderly Patients: Analysis of a Large, National, Observational Cohort

Outcomes of COVID-19 Critically Ill Extremely Elderly Patients: Analysis of a Large, National, Observational Cohort

Dexamethasone in hospitalised COVID-19 patients not on intensive respiratory support

Réanimation et Covid

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