Table 4.
Association of corticosteroid therapy and 90-day mortality
| Univariable analysis | Adjusted analysisa | |||
|---|---|---|---|---|
| HR (95% CI) | p value | Adjusted HR (95% CI) | p value | |
| All patients (N = 4226) | 0.74 (0.63–0.86) | < 0.001 | 0.77 (0.65–0.92) | 0.003 |
| Subgroup analysesb | ||||
| Age group | 0.001c | |||
| Age < 60 years (n = 1611) | 1.25 (0.82–1.90) | 0.296 | 1.33 (0.83–2.11) | 0.233 |
| Age ≥ 60 years (n = 2615) | 0.60 (0.51–0.71) | < 0.001 | 0.69 (0.57–0.83) | < 0.001 |
| Severity of illness at ICU admission group | 0.260c | |||
| APACHE-II score < 12 (n = 1112) | 0.87 (0.57–1.34) | 0.539 | 1.00 (0.60–1.67) | 0.999 |
| APACHE-II score ≥ 12 (n = 1110) | 0.58 (0.44–0.76) | < 0.001 | 0.65 (0.47–0.89) | 0.007 |
| Organ dysfunction and failure at ICU admission group | 0.014c | |||
| SOFA score < 5 (n = 1348) | 1.26 (0.80–1.98) | 0.318 | 1.24 (0.75–2.05) | 0.397 |
| SOFA score ≥ 5 (n = 1354) | 0.61 (0.48–0.79) | < 0.001 | 0.55 (0.42–0.73) | < 0.001 |
| Laboratory findings at ICU admission | ||||
| Lymphocyte count group | 0.159c | |||
| Lymphocyte count < 0.724 × 109/L (n = 2117) | 0.67 (0.54–0.84) | 0.001 | 0.68 (0.53–0.87) | 0.002 |
| Lymphocyte count ≥ 0.724 × 109/L (n = 1808) | 0.76 (0.59–0.98) | 0.033 | 0.89 (0.67–1.18) | 0.430 |
| C-reactive protein group | 0.093c | |||
| C-reactive protein < 150 mg/L (n = 2161) | 0.76 (0.59–0.96) | 0.024 | 0.85 (0.64–1.12) | 0.248 |
| C-reactive protein ≥ 150 mg/L (n = 1769) | 0.67 (0.53–0.83) | < 0.001 | 0.71 (0.55–0.92) | 0.009 |
| Inflammation group | 0.708c | |||
| Low inflammation (n = 707)d | 0.73 (0.41–1.31) | 0.290 | 0.55 (0.27–1.13) | 0.103 |
| Age < 60 years (n = 320) | 0.93 (0.23–3.76) | 0.922 | 0.88 (0.11–7.39) | 0.909 |
| Age ≥ 60 years (n = 387) | 0.52 (0.26–1.03) | 0.061 | 0.43 (0.17–1.10) | 0.079 |
| High inflammation (n = 1943)d | 0.62 (0.48–0.79) | < 0.001 | 0.59 (0.45–0.77) | < 0.001 |
| Age < 60 years (n = 667) | 1.12 (0.55–2.30) | 0.749 | 1.59 (0.66–3.85) | 0.304 |
| Age ≥ 60 years (n = 1276) | 0.51 (0.39–0.66) | < 0.001 | 0.50 (0.37–0.68) | < 0.001 |
| Mechanical ventilation at ICU admission group | 0.001c | |||
| No mechanical ventilation (n = 307) | 1.55 (0.81–2.95) | 0.185 | 1.38 (0.62–3.06) | 0.433 |
| High-flow nasal cannula/non-invasive mechanical ventilation (n = 1678) | 0.96 (0.65–1.43) | 0.859 | 0.70 (0.45–1.09) | 0.115 |
| Invasive mechanical ventilation (n = 2145) | 0.64 (0.53–0.78) | < 0.001 | 0.68 (0.56–0.84) | < 0.001 |
HR hazard ratio, CI confidence interval, APACHE acute physiology and chronic health evaluation, SOFA sequential organ failure assessment
aAdjusted for variables (age, sex, body mass index, diabetes mellitus, chronic liver disease, chronic heart disease, chronic lung disease, chronic renal failure, immunosuppression, APACHE-II score at ICU admission, PaO2/FiO2 ratio at ICU admission, pH at ICU admission, haemoglobin at ICU admission, lymphocyte count at ICU admission, platelet count at ICU admission, D-dimer at ICU admission, C-reactive protein, serum creatinine at ICU admission, LDH at ICU admission, ferritin at ICU admission, mechanical ventilation at ICU admission, septic shock at ICU admission, disseminated intravascular coagulation at ICU admission, tocilizumab administration, COVID-19 wave and the propensity score)
bAPACHE-II score was assessed in 2222 patients; SOFA score in 2702 patients; lymphocyte count in 3925 patients; C-reactive protein in 3930 patients; inflammation in 2650 patients; and mechanical ventilation in 4130 patients
cInteraction effect for the subgroup and treatment group
dHigh inflammation was defined as the fulfilment of at least two of the following criteria: ferritin > 1000 ng/mL or d-dimer > 1000 ng/mL or C-reactive protein > 100 mg/L