{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T01:46:50Z","timestamp":1782784010915,"version":"3.54.5"},"reference-count":30,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: COVID-19 causes adrenal injury that may amplify etomidate-induced adrenal suppression. We compared 30-day mortality between etomidate and ketamine for emergency intubation. Methods: We conducted a TriNetX-based propensity-matched cohort study of adult COVID-19 patients undergoing emergency intubation with etomidate or ketamine (January 2020\u2013June 2025). The primary outcome was 30-day mortality. Three independent propensity-matched cohorts were created using different vasopressor inclusion criteria: primary (no vasopressor on day \u22121), hemodynamically stable (no vasopressor on day \u22121 or day 0), and critically ill (vasopressor on both day \u22121 and day 0). Sensitivity and negative control analyses addressed confounding. Results: Among 9462 primary-cohort pairs, etomidate was associated with higher 30-day mortality (34.43% vs. 31.57%; HR 1.11, 95% CI 1.06\u20131.17, p &lt; 0.001; NNH 35). The association persisted in stable patients (HR 1.16, p = 0.013) and in critically ill patients (HR 1.15, p &lt; 0.001). Mortality hazard ratios rose progressively with longer follow-up (day 0\u20137: HR 1.05; day 0\u201330: HR 1.11), indicating a delayed effect. In stable patients, etomidate was associated with higher vasopressor initiation (HR 1.15, p = 0.005); the between-group difference appeared early (4.41% by day 1) and narrowed thereafter, while the mortality difference emerged later and widened through day 30. Conclusions: Etomidate was consistently associated with higher 30-day mortality in COVID-19 patients (HR 1.11\u20131.16), unlike the results seen in general critical illness. The temporal pattern of early vasopressor divergence and late mortality divergence, together with consistency across hemodynamic strata, supports disease-specific adrenal vulnerability rather than acute peri-intubation harm. Ketamine may be the preferred induction agent in COVID-19 patients without contraindications.<\/jats:p>","DOI":"10.3390\/jcm15135050","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:55:11Z","timestamp":1782780911000},"page":"5050","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Etomidate Is Associated with Higher 30-Day Mortality than Ketamine for Emergency Intubation of COVID-19 Patients: A Propensity-Matched Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2461-3501","authenticated-orcid":false,"given":"Li-Wei","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wenchang Rd., Shihlin Dist., Taipei 11101, Taiwan"},{"name":"School of Medicine, College of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City 24205, Taiwan"},{"name":"CrazyatLAB (Critical Airway Training Laboratory), Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2231-430X","authenticated-orcid":false,"given":"Tzu-Fu","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Research, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wenchang Rd., Shihlin Dist., Taipei 11101, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi-Chieh","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wenchang Rd., Shihlin Dist., Taipei 11101, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chee-Fah","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wenchang Rd., Shihlin Dist., Taipei 11101, Taiwan"},{"name":"School of Medicine, College of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City 24205, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1159\/000534025","article-title":"Hypothalamic-Pituitary Axis Function and Adrenal Insufficiency in COVID-19 Patients","volume":"30","author":"Durcan","year":"2023","journal-title":"Neuroimmunomodulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12020-023-03411-w","article-title":"COVID-19 pandemic and adrenals: Deep insights and implications in patients with glucocorticoid disorders","volume":"82","author":"Cozzolino","year":"2023","journal-title":"Endocrine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1038\/s41467-022-29145-3","article-title":"Adrenal tropism of SARS-CoV-2 and adrenal findings in a post-mortem case series of patients with severe fatal COVID-19","volume":"13","author":"Paul","year":"2022","journal-title":"Nat. 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