Corticosteroids in immunocompromised ICU patients with severe COVID-19: a multicenter retrospective study
Abstract Immunocompromised patients were excluded most of the time from trials testing corticosteroids in COVID-19. This study aimed to assess the associations between early corticosteroid use and (1) mortality at day 60, and (2) the occurrence of nosocomial infections in immunocompromised patients...
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Nature Portfolio
2025-07-01
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| Online Access: | https://doi.org/10.1038/s41598-025-10864-8 |
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| author | Claire Dupuis Jean-François Timsit Julien Domitile Kada Klouche Laure Calvet Mathilde Neuville Shidasp Siami Yves Cohen Virginie Laurent Bruno Mourvillier Dany Goldgran-Toledano Carole Schwebel Stéphane Ruckly Ferhat Meziani Matthieu Raymond Armand Mekontso Dessap Bertrand Souweine |
| author_facet | Claire Dupuis Jean-François Timsit Julien Domitile Kada Klouche Laure Calvet Mathilde Neuville Shidasp Siami Yves Cohen Virginie Laurent Bruno Mourvillier Dany Goldgran-Toledano Carole Schwebel Stéphane Ruckly Ferhat Meziani Matthieu Raymond Armand Mekontso Dessap Bertrand Souweine |
| author_sort | Claire Dupuis |
| collection | DOAJ |
| description | Abstract Immunocompromised patients were excluded most of the time from trials testing corticosteroids in COVID-19. This study aimed to assess the associations between early corticosteroid use and (1) mortality at day 60, and (2) the occurrence of nosocomial infections in immunocompromised patients with severe COVID-19 admitted to the ICU. It was a multicentre retrospective study, achieved in French ICUs of the Outcomerea™ network and medical ICUs of 4 other hospitals in France. This study included immunocompromised patients admitted to an ICU between January 1, 2020, and August 31, 2022, for severe COVID-19, with an ICU stay of more than 2 days. Patients were classified as receiving early corticosteroid therapy if they were given steroids within the first 5 days following ICU admission. Each patient was categorized into one of four immunosuppression subgroups: ‘corticosteroid therapy,’ ‘monocytic alteration,’ ‘cellular immunosuppression,’ or ‘humoral immunosuppression.’ Survival analyses were performed, and confounding by indication was addressed using propensity score weighting with overlap. 383 patients were included, 50 were into the no-early-corticosteroids group and 333 in the early-corticosteroids group. In the overlap cohort, 118 were included (46 in the non-early-corticosteroids and 72 in the early-corticosteroids group). There was no association with day-60 mortality (IPTWoverlapHR = 0.97, 95% CI [0.51; 1.85], p = 0.92). There was also no association with the occurrence of nosocomial infections (IPTWoverlapSubHR = 2.59, CI 95% [0.77; 8.7], p = 0.13). We report that steroids had no benefit on mortality in immunocompromised patients admitted to ICU for severe COVID-19. |
| format | Article |
| id | doaj-art-77abc06113fc43e8809a52e791d6216d |
| institution | DOAJ |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-07-01 |
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| spelling | doaj-art-77abc06113fc43e8809a52e791d6216d2025-08-20T03:05:17ZengNature PortfolioScientific Reports2045-23222025-07-0115111710.1038/s41598-025-10864-8Corticosteroids in immunocompromised ICU patients with severe COVID-19: a multicenter retrospective studyClaire Dupuis0Jean-François Timsit1Julien Domitile2Kada Klouche3Laure Calvet4Mathilde Neuville5Shidasp Siami6Yves Cohen7Virginie Laurent8Bruno Mourvillier9Dany Goldgran-Toledano10Carole Schwebel11Stéphane Ruckly12Ferhat Meziani13Matthieu Raymond14Armand Mekontso Dessap15Bertrand Souweine16Medical Intensive Care Unit, University Hospital Gabriel MontpiedOUTCOMEREA NetworkMedical Intensive Care Unit, University Hospital Gabriel MontpiedDepartment of Intensive Care Medicine, Lapeyronie University Hospital, PhyMedExp, INSERM, CNRS, University of MontpellierMedical Intensive Care Unit, University Hospital Gabriel MontpiedPolyvalent Intensive Care Unit, Hôpital FochGeneral Intensive Care Unit, Sud Essonne HospitalIntensive Care Unit, University Hospital Avicenne, AP-HPPolyvalent Intensive Care Unit, André Mignot HospitalMedical Intensive Care Unit, University Hospital of ReimsMedical and Surgical Intensive Care, Montfermeil HospitalMedical Intensive Care Unit, University Hospital Grenoble-AlpesOUTCOMEREA NetworkFaculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Université de Strasbourg (UNISTRA)Medical Intensive Care Unit, University Hospital of NantesService de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique CARMAS, Faculté de Médecine de Créteil, Université Paris Est CréteilMedical Intensive Care Unit, University Hospital Gabriel MontpiedAbstract Immunocompromised patients were excluded most of the time from trials testing corticosteroids in COVID-19. This study aimed to assess the associations between early corticosteroid use and (1) mortality at day 60, and (2) the occurrence of nosocomial infections in immunocompromised patients with severe COVID-19 admitted to the ICU. It was a multicentre retrospective study, achieved in French ICUs of the Outcomerea™ network and medical ICUs of 4 other hospitals in France. This study included immunocompromised patients admitted to an ICU between January 1, 2020, and August 31, 2022, for severe COVID-19, with an ICU stay of more than 2 days. Patients were classified as receiving early corticosteroid therapy if they were given steroids within the first 5 days following ICU admission. Each patient was categorized into one of four immunosuppression subgroups: ‘corticosteroid therapy,’ ‘monocytic alteration,’ ‘cellular immunosuppression,’ or ‘humoral immunosuppression.’ Survival analyses were performed, and confounding by indication was addressed using propensity score weighting with overlap. 383 patients were included, 50 were into the no-early-corticosteroids group and 333 in the early-corticosteroids group. In the overlap cohort, 118 were included (46 in the non-early-corticosteroids and 72 in the early-corticosteroids group). There was no association with day-60 mortality (IPTWoverlapHR = 0.97, 95% CI [0.51; 1.85], p = 0.92). There was also no association with the occurrence of nosocomial infections (IPTWoverlapSubHR = 2.59, CI 95% [0.77; 8.7], p = 0.13). We report that steroids had no benefit on mortality in immunocompromised patients admitted to ICU for severe COVID-19.https://doi.org/10.1038/s41598-025-10864-8ImmunosuppressionICUCOVID-19SteroidsOutcomesNosocomial infections |
| spellingShingle | Claire Dupuis Jean-François Timsit Julien Domitile Kada Klouche Laure Calvet Mathilde Neuville Shidasp Siami Yves Cohen Virginie Laurent Bruno Mourvillier Dany Goldgran-Toledano Carole Schwebel Stéphane Ruckly Ferhat Meziani Matthieu Raymond Armand Mekontso Dessap Bertrand Souweine Corticosteroids in immunocompromised ICU patients with severe COVID-19: a multicenter retrospective study Scientific Reports Immunosuppression ICU COVID-19 Steroids Outcomes Nosocomial infections |
| title | Corticosteroids in immunocompromised ICU patients with severe COVID-19: a multicenter retrospective study |
| title_full | Corticosteroids in immunocompromised ICU patients with severe COVID-19: a multicenter retrospective study |
| title_fullStr | Corticosteroids in immunocompromised ICU patients with severe COVID-19: a multicenter retrospective study |
| title_full_unstemmed | Corticosteroids in immunocompromised ICU patients with severe COVID-19: a multicenter retrospective study |
| title_short | Corticosteroids in immunocompromised ICU patients with severe COVID-19: a multicenter retrospective study |
| title_sort | corticosteroids in immunocompromised icu patients with severe covid 19 a multicenter retrospective study |
| topic | Immunosuppression ICU COVID-19 Steroids Outcomes Nosocomial infections |
| url | https://doi.org/10.1038/s41598-025-10864-8 |
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