Early adoption of critical care interventions is unjustifiable without concomitant effectiveness study

Gershengorn, Hayley B.

doi:10.1186/s13054-020-03382-8

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…First, although phenotypes were found to be generalizable in our population (after validation), risk factors and characteristics that pre-de ned these clinical phenotypes were derived initially from data at ICU admission of a multicenter observational study in Spain. However, at the same time these risk factors are similar to those that have been reported by other investigators [38][39][40][41][42][43][44][45][46][47] which suggests its applicability to other populations. Despite this, our phenotypes should be validated into other critical patient populations to assess reproducibility and cross-application.…”

Section: Discussionsupporting

confidence: 88%

“…Several limitations have been reported since its publication. 2 , 3 , 32 , 33 Possibly the most important limitations are the lack of an adjustment according to severity of illness to minimize potential bias and that mortality has been censored at 28 days, and no data have been published from the mortality at ICU or hospital discharge.…”

Section: Discussionmentioning

confidence: 99%

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A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients

Moreno¹,

Ruíz-Botella²,

Martín‐Loeches³

et al. 2023

Medicina Intensiva (English Edition)

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients

Moreno¹,

Ruíz-Botella²,

Martín‐Loeches³

et al. 2023

Medicina Intensiva (English Edition)

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Section: Discussionsupporting

confidence: 88%

A Differential Therapeutic Consideration for use of Corticosteroids According to Established COVID-19 Clinical Phenotypes in Critically Ill Patients

Moreno

Botella

Martín‐Loeches³

et al. 2021

Preprint

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Background: The steroids are currently used as standard treatment for severe COVID-19. However, the evidence is weak. Our aim is to determine if the use of corticosteroids was associated with Intensive Care Unit (ICU) mortality among whole population and pre-specified clinical phenotypes.Methods: A secondary analysis derived from multicenter, observational study of adult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain. Three phenotypes were derived by non-supervised clustering analysis from whole population and classified as (A: severe, B: critical and C: life-threatening). The primary outcome was ICU mortality. We performed a Multivariate analysis after propensity score full matching (PS), Cox proportional hazards (CPH), Cox covariate time interaction (TIR), Weighted Cox Regression (WCR) and Fine-Gray analysis(sHR) to assess the impact of corticosteroids on ICU mortality according to the whole population and distinctive patient clinical phenotypes. Results: A total of 2,017 patients were analyzed, 1171(58%) with corticosteroids. After PS, corticosteroids were shown not to be associated with ICU mortality (OR:1.0,95%CI:0.98-1.15). Corticosteroids were administered in 298/537(55.5%) patients of “A” phenotype and their use was not associated with ICU mortality (HR=0.85[0.55-1.33]). A total of 338/623(54.2%) patients in “B” phenotype received corticosteroids. The CPH (HR =0.65 [0.46-0.91]) and TIR regression (1- 25 day tHR=0.56[0.39-0.82] and >25 days tHR=1.53[1.03-7.12]) showed a biphasic effect of corticosteroids due to proportional assumption violation. No effect of corticosteroids on ICU mortality was observed when WCR was performed (wHR=0.72[0.49-1.05]). Finally, 535/857(62.4%) patients in “C” phenotype received corticosteroids. The CPH (HR=0.73[0.63-0.98]) and TIR regression (1- 25 day tHR=0.69[ 0.53-0.89] and >25 days tHR=1.30[ 1.14-3.25]) showed a biphasic effect of corticosteroids and proportional assumption violation. However, wHR (0.75[0.58-0.98]) and sHR (0.79[0.63-0.98]) suggest a protective effect of corticosteroids on ICU mortality. Conclusion: Our finding warns against the widespread use of corticosteroids in all critically ill patients with COVID-19 at moderate-high dose. Only patients with the highest severity could benefit from steroid treatment although this effect on clinical outcome was minimized during ICU stay.

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“…This observation is contrary to the current recommendation of dexamethasone treatment according to the RECOVERY trial (8), that showed that the mortality from COVID-19 was lower among patients who were randomized to receive dexamethasone than among those who received the standard of care. Several limitations have been reported since its publication (2,3,32,33). Possibly the most important limitations are the lack of an adjustment according to severity of illness to minimize potential bias and that mortality has been censored at 28 days, and no data have been published from the mortality at ICU or Hospital discharge.…”

Section: Discussionmentioning

confidence: 99%

A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients

et al. 2023

View full text Add to dashboard Cite

show abstract

Early adoption of critical care interventions is unjustifiable without concomitant effectiveness study

Cited by 6 publications

References 14 publications

A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients

A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients

A Differential Therapeutic Consideration for use of Corticosteroids According to Established COVID-19 Clinical Phenotypes in Critically Ill Patients

A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients

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