{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T18:28:57Z","timestamp":1749061737987,"version":"3.37.3"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,5,27]],"date-time":"2024-05-27T00:00:00Z","timestamp":1716768000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,5,27]],"date-time":"2024-05-27T00:00:00Z","timestamp":1716768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002839","name":"Charit\u00e9 - Universit\u00e4tsmedizin Berlin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002839","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The COVID-19 pandemic has posed a major challenge to healthcare systems globally. Millions of people have been infected, and millions of deaths have been reported worldwide. Glucocorticoids have attracted worldwide attention for their potential efficacy in the treatment of COVID-19. Various glucocorticoids with different dosages and treatment durations have been studied in patients with different severities, with a suitable dosage and treatment duration not yet defined. This study aimed to investigate whether in-hospital survival differs between critically ill patients treated with low-dose glucocorticoids, high-dose glucocorticoids or no glucocorticoids. All critically ill patients admitted to the intensive care unit of the Charit\u00e9 Hospital\u2014Universit\u00e4tsmedizin Berlin between February 2020 and December 2021 with COVID-19 pneumonia receiving supplemental oxygen were eligible to participate in this multicenter real-world data study. Patients were retrospectively assigned to one of three groups: the high corticosteroid dose (HighC) group (receiving 6\u00a0mg parenteral dexamethasone or an equivalent corticosteroid dosage for ten days), the low corticosteroid dose (LowC) group (receiving less than 6\u00a0mg parenteral dexamethasone or an equivalent corticosteroid dosage for ten days), or the no corticosteroid (NoC) group. Overall survival and risk effects were compared among groups within the total observation period, as well as at 35\u00a0days after the onset of COVID-19 symptoms. Adjusted multivariable Cox proportional hazard regression analysis was performed to compare the risk of death between the treatment groups. Out of 1561 critically ill COVID-19 patients, 1014 were included in the baseline analysis. In the survival study, 1009 patients were assigned to the NoC (n\u2009=\u2009346), HighC (n\u2009=\u2009552), or LowC group (n\u2009=\u2009111). The baseline characteristics were balanced between groups, except for age, BMI, APACHE II score, SOFA and SAPS II. While the 35-day survival did not show any differences, a landmark analysis of the patients surviving beyond 35\u00a0days revealed differences between groups. The restricted mean survival time was 112\u00a0days in the LowC group [95% CI: 97 \u2013 128], 133\u00a0days in the HighC group [95% CI: 124 \u2013 141] and 144\u00a0days in the NoC group [95% CI: 121 \u2013 167]. The multivariable-adjusted Cox proportional hazard analysis indicated that, regardless of age, sex, health status or invasive oxygenation, a low-dose treatment increased the hazard of death of critically ill COVID-19 patients by a factor of 2.09 ([95% CI: 0.99, 4.4], <jats:italic>p<\/jats:italic>\u2009=\u20090.05) and a high-dose corticosteroid treatment increased the risk by a factor of 1.07 ([95% CI: 0.53, 2.15], <jats:italic>p<\/jats:italic>\u2009=\u20090.85) compared to no treatment with glucocorticoids. The analysis reveals that corticosteroid treatment does not influence the survival of critically ill COVID-19 patients in the intensive care unit within 35\u00a0days. Our evaluations further suggest that regardless of ventilation status, the decision-making process for administering corticosteroid therapy should account for the individual severity of the illness.<\/jats:p>","DOI":"10.1038\/s41598-024-62302-w","type":"journal-article","created":{"date-parts":[[2024,5,27]],"date-time":"2024-05-27T18:02:05Z","timestamp":1716832925000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["In-hospital survival of critically ill COVID-19 patients treated with glucocorticoids: a multicenter real-world data study"],"prefix":"10.1038","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5440-6968","authenticated-orcid":false,"given":"Stefan","family":"Angermair","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9548-2118","authenticated-orcid":false,"given":"Jan-Hendrik","family":"Hardenberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6174-6346","authenticated-orcid":false,"given":"Kerstin","family":"Rubarth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1575-2056","authenticated-orcid":false,"given":"Felix","family":"Balzer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3481-4956","authenticated-orcid":false,"given":"Nilufar","family":"Akbari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1340-9211","authenticated-orcid":false,"given":"Mario","family":"Menk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1062-0495","authenticated-orcid":false,"given":"Claudia","family":"Spies","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3823-0920","authenticated-orcid":false,"given":"Kai-Uwe","family":"Eckardt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6417-8719","authenticated-orcid":false,"given":"Denis","family":"Poddubnyy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0055-958X","authenticated-orcid":false,"given":"Britta","family":"Siegmund","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1125-0518","authenticated-orcid":false,"given":"Thomas","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0549-7680","authenticated-orcid":false,"given":"Sascha","family":"Treskatsch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,5,27]]},"reference":[{"issue":"4","key":"62302_CR1","doi-asserted-by":"publisher","first-page":"2100979","DOI":"10.1183\/13993003.00979-2021","volume":"58","author":"C Jung","year":"2021","unstructured":"Jung, C. et al. Steroid use in elderly critically ill COVID-19 patients. Eur. Respir. J. 58(4), 2100979 (2021).","journal-title":"Eur. Respir. J."},{"issue":"13","key":"62302_CR2","doi-asserted-by":"publisher","first-page":"1330","DOI":"10.1001\/jama.2020.17023","volume":"324","author":"JA Sterne","year":"2020","unstructured":"Sterne, J. A. et al. Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: a meta-analysis. Jama 324(13), 1330\u20131341 (2020).","journal-title":"Jama"},{"issue":"4","key":"62302_CR3","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1177\/0897190021998502","volume":"35","author":"M Johns","year":"2022","unstructured":"Johns, M., George, S., Taburyanskaya, M. & Poon, Y. K. A review of the evidence for corticosteroids in COVID-19. J. Pharm. Pract. 35(4), 626\u2013637 (2022).","journal-title":"J. Pharm. 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Corticosteroids as risk factor for COVID-19-associated pulmonary aspergillosis in intensive care patients. Crit. Care 26(1), 30 (2022).","journal-title":"Crit. Care"},{"issue":"4","key":"62302_CR10","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1038\/nri.2017.1","volume":"17","author":"DW Cain","year":"2017","unstructured":"Cain, D. W. & Cidlowski, J. A. Immune regulation by glucocorticoids. Nat. Rev. Immunol. 17(4), 233\u2013247 (2017).","journal-title":"Nat. Rev. Immunol."},{"key":"62302_CR11","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.588584","volume":"8","author":"JE Hartmann","year":"2021","unstructured":"Hartmann, J. E., Albrich, W. C., Dmitrijeva, M. & Kahlert, C. R. The effects of corticosteroids on the respiratory microbiome: a systematic review. Front. Med. (Lausanne) 8, 588584 (2021).","journal-title":"Front. Med. 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Scand."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-62302-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-62302-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-62302-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,27]],"date-time":"2024-05-27T18:04:21Z","timestamp":1716833061000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-62302-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,27]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["62302"],"URL":"https:\/\/doi.org\/10.1038\/s41598-024-62302-w","relation":{},"ISSN":["2045-2322"],"issn-type":[{"type":"electronic","value":"2045-2322"}],"subject":[],"published":{"date-parts":[[2024,5,27]]},"assertion":[{"value":"8 February 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 May 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 May 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Regarding potential conflicts of interest, it is hereby disclosed that the author SA has no conflicts to declare. Outside the submitted work, FB reports grants from the German Federal Ministry of Education and Research, grants from the German Federal Ministry of Health, grants from the Berlin Institute of Health, personal fees from Elsevier Publishing, grants from Hans B\u00f6ckler Foundation, others from Robert Koch Institute, grants from Einstein Foundation, grants from Berlin University Alliance, personal fees from Medtronic, personal fees from GE Healthcare. ST received funding within an institutional research grant from Orion Pharma and Edwards as well as honoraria for lectures\/workshops\/advisory from Edwards, Orion Pharma, Amomed, Cytosorbents, Philips and Smith & Nephews outside the submitted work. The other authors have declared that no competing interests exist. There are no other relationships\/conditions\/circumstances that present a potential conflict of interest. There are no patents, products in development or marketed products to declare. This does not alter our adherence to Critical Care policies on sharing data and materials. For any other aspects of the submitted work, no payment was received<b>.<\/b>","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"12138"}}