The Role of Inhaled Corticosteroids (ICS) in Critically Ill Patients With COVID-19: A Multicenter, Cohort Study
Khalid Al Sulaiman, PharmD, BCCCP Ohoud Aljuhani, PharmD Kholoud Al Aamer, PharmD Omar Al Shaya, PharmD, BCCCP Abdulrahman Al Shaya, MD Alawi S Alsaeedi, PharmD Alaa Alhubaishi, PharmD, BCPS Ali F Altebainawi, PharmD Alaa Al Harthi, PharmD Shorouq Albelwi, PharmD Rahaf Almutairi, PharmD Norah Alsubaie, PharmD Alanoud Alsallum, PharmD Ghazwa B Korayem, PharmD Amjaad Alfahed, PharmD Raed Kensara, MD Elaf F Altebainawi, PharmD Raghdah S Alenezi, MD Thamer Alsulaiman, PharmD Huda Al Enazi, PhD Statistics Ramesh Vishwakarma, MD Tarek Al Dabbagh, MD Umar Bakhsh, MD Ghassan Al Ghamdi
Journal of Intensive Care Medicine, doi:10.1177/08850666211053548
Background: Severe coronavirus disease 2019 (COVID-19) can boost the systematic inflammatory response in critically ill patients, causing a systemic hyperinflammatory state leading to multiple complications. In COVID-19 patients, the use of inhaled corticosteroids (ICS) is surrounded by controversy regarding their impacts on viral infections. This study aims to evaluate the safety and efficacy of ICS in critically ill patients with COVID-19 and its clinical outcomes. Method: A multicenter, noninterventional, cohort study for critically ill patients with COVID-19 who received ICS. All patients aged ≥ 18 years old with confirmed COVID-19 and admitted to intensive care units (ICUs) between March 1, 2020 and March 31, 2021 were screened. Eligible patients were classified into two groups based on the use of ICS ± long-acting beta-agonists (LABA) during ICU stay. Propensity score (PS)-matched was used based on patient's Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, systemic corticosteroids use, and acute kidney injury (AKI) within 24 h of ICU admission. We considered a P-value of < 0.05 statistically significant. Results: A total of 954 patients were eligible; 130 patients were included after PS matching (1:1 ratio). The 30-day mortality (hazard ratio [HR] [95% confidence interval [CI]]: 0.53 [0.31, 0.93], P-value = 0.03) was statistically significant lower in patients who received ICS. Conversely, the in-hospital mortality, ventilator-free days (VFDs), ICU length of stay (LOS), and hospital LOS were not statistically significant between the two
Author's Contribution Khalid Al Sulaiman: conceptualization, methodology, software, data curation, writing -0riginal draft preparation, coordination, and management, visualization, investigation. Ohoud Aljuhani: conceptualization, literature review, methodology, investigation, data acquisition and processing, supervision, research coordination, and management, revising and editing the manuscript. Kholoud Al Aamer: data acquisition, data analysis, data processing, data preparation, and original draft writing. Omar Al Shaya: data acquisition, data analysis, data processing, data preparation, interpretation of the data and original draft writing. Abdulrahman Al Shaya: data acquisition, data analysis, data processing, data preparation, interpretation of the data and original draft writing. Alawi S. Alsaeedi: data acquisition, data analysis, data processing, data preparation, interpretation of the data and original draft writing. Alaa Alhubaishi: data curation, writing-original draft, revising and editing the manuscript, visualization, investigation and data interpretation. Ali F. Altebainawi: methodology, software, data curation, revising and editing the manuscript, supervision, visualization, investigation. Alaa Al Harthi: data acquisition, data analysis, data processing, data preparation, and original draft writing. Shorouq Albelwi: data acquisition, data analysis, data processing, data preparation, and original draft writing. Rahaf Almutairi: data acquisition, data analysis,..
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