Moreno, GerardCarbonell, RaquelMartin-Loeches, IgnacioSole-Violan, JordiFraga, Eudald Correig, IGomez, JosepRuiz-Botella, ManuelTrefler, SandraBodi, MariaPaya, Josefa MurciaDiaz, EmiliVidal-Cortes, PabloPapiol, ElisabethAlbaya Moreno, AntonioSancho Chinesta, SusanaSocias Crespi, LorenzoDel Carmen Lorente, MariaLoza Vazquez, AnaVara Arlanzon, RebecaTeresa Recio, MariaCarlos Ballesteros, JuanFerrer, RicardFernandez Rey, ElisabethRestrepo, Marcos, IEstella, AngelMargarit Ribas, AntonioGuasch, NeusReyes, Luis F.Marin-Corral, JudithRodriguez, AlejandroCOVID-19 SEMICYUC Working Grp2025-01-072025-01-072021-11-262110-5820https://hdl.handle.net/10668/25114Background Some unanswered questions persist regarding the effectiveness of corticosteroids for severe coronavirus disease 2019 (COVID-19) patients. We aimed to assess the clinical effect of corticosteroids on intensive care unit (ICU) mortality among mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients. Methods This was a retrospective study of prospectively collected data conducted in 70 ICUs (68 Spanish, one Andorran, one Irish), including mechanically ventilated COVID-19-associated ARDS patients admitted between February 6 and September 20, 2020. Individuals who received corticosteroids for refractory shock were excluded. Patients exposed to corticosteroids at admission were matched with patients without corticosteroids through propensity score matching. Primary outcome was all-cause ICU mortality. Secondary outcomes were to compare in-hospital mortality, ventilator-free days at 28 days, respiratory superinfection and length of stay between patients with corticosteroids and those without corticosteroids. We performed survival analysis accounting for competing risks and subgroup sensitivity analysis. Results We included 1835 mechanically ventilated COVID-19-associated ARDS, of whom 1117 (60.9%) received corticosteroids. After propensity score matching, ICU mortality did not differ between patients treated with corticosteroids and untreated patients (33.8% vs. 30.9%; p = 0.28). In survival analysis, corticosteroid treatment at ICU admission was associated with short-term survival benefit (HR 0.53; 95% CI 0.39-0.72), although beyond the 17th day of admission, this effect switched and there was an increased ICU mortality (long-term HR 1.68; 95% CI 1.16-2.45). The sensitivity analysis reinforced the results. Subgroups of ageenAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/CorticosteroidsCOVID-19-associated acute respiratory distress syndromeIntensive care unitMortalityInvasive mechanical ventilationCovid-19research article34825976open access10.1186/s13613-021-00951-0https://annalsofintensivecare.springeropen.com/counter/pdf/10.1186/s13613-021-00951-0722860400002