BACKGROUND: Critically ill patients with coronavirus disease 19 (COVID-19) have a high fatality rate likely due to a dysregulated immune response . Corticosteroids could attenuate this inappropriate response, although there are still some concerns regarding its use, timing, and dose .
METHODS: This is a nationwide, prospective, multicenter, observational, cohort study in critically ill adult patients with COVID-19 admitted into Intensive Care Units (ICU) in Spain from 12th March to 29th June 2020 . Using a multivariable Cox model with inverse probability weighting, we compared relevant outcomes between patients treated with early corticosteroids (before or within the first 48 h of ICU admission) with those who did not receive early corticosteroids (delayed group) or any corticosteroids at all (never group). Primary endpoint was ICU mortality . Secondary endpoints included 7-day mortality, ventilator-free days, and complications .
RESULTS: A total of 691 patients out of 882 (78.3 %) received corticosteroid during their hospital stay . Patients treated with early-corticosteroids (n = 485) had lower ICU mortality (30.3% vs. never 36.6% and delayed 44.2 %) and lower 7-day mortality (7.2% vs. never 15.2 %) compared to non-early treated patients . They also had higher number of ventilator-free days, less length of ICU stay, and less secondary infections than delayed treated patients . There were no differences in medical complications between groups . Of note, early use of moderate-to-high doses was associated with better outcomes than low dose regimens .
CONCLUSION: Early use of corticosteroids in critically ill patients with COVID-19 is associated with lower mortality than no or delayed use, and fewer complications than delayed use.