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Background: Corticosteroid therapy is used commonly in patients with COVID-19, although its impact on outcomes and which patients could benefit from corticosteroid therapy are uncertain.

Research Question: Are clinical phenotypes of COVID-19 associated with differential response to corticosteroid therapy?

Study Design and Methods: Critically ill patients with COVID-19 from Tongji Hospital treated between January and February 2020 were included, and the main exposure of interest was the administration of IV corticosteroids. The primary outcome was 28-day mortality. Marginal structural modeling was used to account for baseline and time-dependent confounders. An unsupervised machine learning approach was carried out to identify phenotypes of COVID-19.

Results: A total of 428 patients were included; 280 of 428 patients (65.4%) received corticosteroid therapy. The 28-day mortality was significantly higher in patients who received corticosteroid therapy than in those who did not (53.9% vs 19.6%; P < .0001). After marginal structural modeling, corticosteroid therapy was not associated significantly with 28-day mortality (hazard ratio [HR], 0.80; 95% CI, 0.54-1.18; P = .26). Our analysis identified two phenotypes of COVID-19, and compared with the hypoinflammatory phenotype, the hyperinflammatory phenotype was characterized by elevated levels of proinflammatory cytokines, higher Sequential Organ Failure Assessment scores, and higher rates of complications. Corticosteroid therapy was associated with a reduced 28-day mortality (HR, 0.45; 95% CI, 0.25-0.80; P = .0062) in patients with the hyperinflammatory phenotype.

Interpretation: For critically ill patients with COVID-19, corticosteroid therapy was not associated with 28-day mortality, but the use of corticosteroids showed significant survival benefits in patients with the hyperinflammatory phenotype.

Titel:	Corticosteroid Therapy Is Associated With Improved Outcome in Critically Ill Patients With COVID-19 With Hyperinflammatory Phenotype.
Autor/in / Beteiligte Person:	Chen, H ; Xie, J ; Su, N ; Wang, J ; Sun, Q ; Li, S ; Jin, J ; Zhou, J ; Mo, M ; Wei, Y ; Chao, Y ; Hu, W ; Du, B ; Qiu, H
Zeitschrift:	Chest, Jg. 159 (2021-05-01), Heft 5, S. 1793-1802
Veröffentlichung:	2016- : New York : Elsevier ; <i>Original Publication</i>: Chicago : American College of Chest Physicians, 2021
Medientyp:	academicJournal
ISSN:	1931-3543 (electronic)
DOI:	10.1016/j.chest.2020.11.050
Schlagwort:	Aged China epidemiology Critical Care methods Critical Care statistics & numerical data Female Humans Male Middle Aged Mortality Organ Dysfunction Scores Outcome and Process Assessment, Health Care SARS-CoV-2 Severity of Illness Index Adrenal Cortex Hormones therapeutic use COVID-19 complications COVID-19 immunology COVID-19 mortality COVID-19 therapy Critical Illness mortality Critical Illness therapy Inflammation mortality Inflammation therapy
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [Chest] 2021 May; Vol. 159 (5), pp. 1793-1802. <i>Date of Electronic Publication: </i>2020 Dec 13. MeSH Terms: COVID-19* / complications ; COVID-19* / immunology ; COVID-19* / mortality ; COVID-19* / therapy ; Critical Illness* / mortality ; Critical Illness* / therapy ; Inflammation* / mortality ; Inflammation* / therapy ; Adrenal Cortex Hormones / *therapeutic use ; Aged ; China / epidemiology ; Critical Care / methods ; Critical Care / statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Mortality ; Organ Dysfunction Scores ; Outcome and Process Assessment, Health Care ; SARS-CoV-2 ; Severity of Illness Index Comments: Comment in: Chest. 2021 May;159(5):1693-1695. (PMID: 33965120) References: N Engl J Med. 2021 Feb 25;384(8):693-704. (PMID: 32678530) ; Intensive Care Med. 2017 Dec;43(12):1751-1763. (PMID: 28940011) ; Crit Care. 2016 Mar 30;20:75. (PMID: 27036638) ; Crit Care Explor. 2020 Apr 29;2(4):e0111. (PMID: 32426753) ; N Engl J Med. 2020 Mar 5;382(10):929-936. (PMID: 32004427) ; JAMA. 2020 Apr 14;323(14):1335. (PMID: 32181795) ; Influenza Other Respir Viruses. 2017 Jul;11(4):345-354. (PMID: 28464462) ; Am J Respir Crit Care Med. 2018 Mar 15;197(6):757-767. (PMID: 29161116) ; Intensive Care Med. 2020 May;46(5):837-840. (PMID: 32123994) ; JAMA. 2016 Feb 23;315(8):801-10. (PMID: 26903338) ; N Engl J Med. 2020 Feb 20;382(8):727-733. (PMID: 31978945) ; Am J Respir Crit Care Med. 2017 Feb 1;195(3):331-338. (PMID: 27513822) ; JAMA. 2020 Mar 17;323(11):1061-1069. (PMID: 32031570) ; Ecol Evol. 2019 Nov 19;9(23):13231-13243. (PMID: 31871641) ; Bioinformatics. 2010 Jun 15;26(12):1572-3. (PMID: 20427518) ; Nephron Clin Pract. 2012;120(4):c179-84. (PMID: 22890468) ; J Med Virol. 2021 Jan;93(1):250-256. (PMID: 32592501) ; Allergy. 2020 Jul;75(7):1564-1581. (PMID: 32396996) ; Biometrics. 2007 Dec;63(4):1031-7. (PMID: 17425640) ; Crit Care Med. 2020 Feb;48(2):e98-e106. (PMID: 31939808) ; Chest. 2009 Dec;136(6):1631-1643. (PMID: 19801579) ; JAMA. 2020 May 12;323(18):1824-1836. (PMID: 32282022) ; JAMA Intern Med. 2020 Jul 1;180(7):934-943. (PMID: 32167524) ; Crit Care Med. 2016 Jun;44(6):e318-28. (PMID: 26934144) ; J Infect. 2007 Jan;54(1):28-39. (PMID: 16542729) ; Lancet. 2020 Mar 28;395(10229):1033-1034. (PMID: 32192578) ; Lancet Respir Med. 2020 May;8(5):475-481. (PMID: 32105632) ; Stat Med. 1986 Jan-Feb;5(1):21-7. (PMID: 3961312) ; Crit Care Med. 2009 Apr;37(4):1317-21. (PMID: 19242333) ; Chest. 2006 Jun;129(6):1441-52. (PMID: 16778260) ; Nature. 2020 Jul;583(7816):437-440. (PMID: 32434211) Contributed Indexing: Keywords: COVID-19; corticosteroid; phenotype Substance Nomenclature: 0 (Adrenal Cortex Hormones) Entry Date(s): Date Created: 20201214 Date Completed: 20210518 Latest Revision: 20210527 Update Code: 20240513 PubMed Central ID: PMC7834518

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Corticosteroid Therapy Is Associated With Improved Outcome in Critically Ill Patients With COVID-19 With Hyperinflammatory Phenotype.