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Corticosteroid use in the intensive care unit: at what cost?
Arch Surg. 2006 Feb; 141(2):145-9; discussion 149.AS

Abstract

HYPOTHESIS

Corticosteroid use has a significant effect on morbidity and mortality in the intensive care unit (ICU).

DESIGN

Case-control study.

SETTING

Burn-trauma ICU in a level 1 trauma center.

PATIENTS

All patients who received corticosteroids while in the ICU from January 1, 2002, to December 31, 2003 (n = 100), matched by age and Injury Severity Score with a control group (n = 100).

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

We considered the following 7 outcomes: pneumonia, bloodstream infection, urinary tract infection, other infections, ICU length of stay (LOS), ventilator LOS, and mortality.

RESULTS

Cases and controls had similar APACHE II (Acute Physiology and Chronic Health Evaluation II) scores and medical history. In univariate analysis, the corticosteroid group had a significant increase in pneumonia (26% vs 12%; P<.01), bloodstream infection (19% vs 7%; P<.01), and urinary tract infection (17% vs 8%; P<.05). In multivariate models, corticosteroid use was associated with an increased rate of pneumonia (odds ratio [OR], 2.64; 95% confidence interval [CI], 1.21-5.75) and bloodstream infection (OR, 3.25; 95% CI, 1.26-8.37). There was a trend toward increased urinary tract infection (OR, 2.31; 95% CI, 0.94-5.69), other infections (OR, 2.57; 95% CI, 0.87-7.67), and mortality (OR, 1.89; 95% CI, 0.81-4.40). Patients in the ICU who received corticosteroids had a longer ICU LOS by 7 days (P<.01) and longer ventilator LOS by 5 days (P<.01).

CONCLUSIONS

Corticosteroid use is associated with increased rate of infection, increased ICU and ventilator LOS, and a trend toward increased mortality. Caution must be taken to carefully consider the indications, risks, and benefits of corticosteroids when deciding on their use.

Authors+Show Affiliations

Department of Surgery, Eastern Virginia Medical School, Norfolk 23507, USA. brittrc@evms.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16490890

Citation

Britt, Rebecca C., et al. "Corticosteroid Use in the Intensive Care Unit: at what Cost?" Archives of Surgery (Chicago, Ill. : 1960), vol. 141, no. 2, 2006, pp. 145-9; discussion 149.
Britt RC, Devine A, Swallen KC, et al. Corticosteroid use in the intensive care unit: at what cost? Arch Surg. 2006;141(2):145-9; discussion 149.
Britt, R. C., Devine, A., Swallen, K. C., Weireter, L. J., Collins, J. N., Cole, F. J., & Britt, L. D. (2006). Corticosteroid use in the intensive care unit: at what cost? Archives of Surgery (Chicago, Ill. : 1960), 141(2), 145-9; discussion 149.
Britt RC, et al. Corticosteroid Use in the Intensive Care Unit: at what Cost. Arch Surg. 2006;141(2):145-9; discussion 149. PubMed PMID: 16490890.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Corticosteroid use in the intensive care unit: at what cost? AU - Britt,Rebecca C, AU - Devine,Alicia, AU - Swallen,Karen C, AU - Weireter,Leonard J, AU - Collins,Jay N, AU - Cole,Frederic J, AU - Britt,L D, PY - 2006/2/24/pubmed PY - 2006/3/8/medline PY - 2006/2/24/entrez SP - 145-9; discussion 149 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 141 IS - 2 N2 - HYPOTHESIS: Corticosteroid use has a significant effect on morbidity and mortality in the intensive care unit (ICU). DESIGN: Case-control study. SETTING: Burn-trauma ICU in a level 1 trauma center. PATIENTS: All patients who received corticosteroids while in the ICU from January 1, 2002, to December 31, 2003 (n = 100), matched by age and Injury Severity Score with a control group (n = 100). INTERVENTIONS: None. MAIN OUTCOME MEASURES: We considered the following 7 outcomes: pneumonia, bloodstream infection, urinary tract infection, other infections, ICU length of stay (LOS), ventilator LOS, and mortality. RESULTS: Cases and controls had similar APACHE II (Acute Physiology and Chronic Health Evaluation II) scores and medical history. In univariate analysis, the corticosteroid group had a significant increase in pneumonia (26% vs 12%; P<.01), bloodstream infection (19% vs 7%; P<.01), and urinary tract infection (17% vs 8%; P<.05). In multivariate models, corticosteroid use was associated with an increased rate of pneumonia (odds ratio [OR], 2.64; 95% confidence interval [CI], 1.21-5.75) and bloodstream infection (OR, 3.25; 95% CI, 1.26-8.37). There was a trend toward increased urinary tract infection (OR, 2.31; 95% CI, 0.94-5.69), other infections (OR, 2.57; 95% CI, 0.87-7.67), and mortality (OR, 1.89; 95% CI, 0.81-4.40). Patients in the ICU who received corticosteroids had a longer ICU LOS by 7 days (P<.01) and longer ventilator LOS by 5 days (P<.01). CONCLUSIONS: Corticosteroid use is associated with increased rate of infection, increased ICU and ventilator LOS, and a trend toward increased mortality. Caution must be taken to carefully consider the indications, risks, and benefits of corticosteroids when deciding on their use. SN - 0004-0010 UR - https://www.unboundmedicine.com/medline/citation/16490890/Corticosteroid_use_in_the_intensive_care_unit:_at_what_cost DB - PRIME DP - Unbound Medicine ER -