Corticosteroid Therapy for Critically Ill Patients with Middle East Respiratory Syndrome.Am J Respir Crit Care Med 2018; 197(6):757-767AJ
Abstract
RATIONALE
Corticosteroid therapy is commonly used among critically ill patients with Middle East Respiratory Syndrome (MERS), but its impact on outcomes is uncertain. Analyses of observational studies often do not account for patients' clinical condition at the time of corticosteroid therapy initiation.
OBJECTIVES
To investigate the association of corticosteroid therapy on mortality and on MERS coronavirus RNA clearance in critically ill patients with MERS.
METHODS
ICU patients with MERs were included from 14 Saudi Arabian centers between September 2012 and October 2015. We performed marginal structural modeling to account for baseline and time-varying confounders.
MEASUREMENTS AND MAIN RESULTS
Of 309 patients, 151 received corticosteroids. Corticosteroids were initiated at a median of 3.0 days (quartile 1 [Q1]-Q3, 1.0-7.0) from ICU admission. Patients who received corticosteroids were more likely to receive invasive ventilation (141 of 151 [93.4%] vs. 121 of 158 [76.6%]; P < 0.0001) and had higher 90-day crude mortality (112 of 151 [74.2%] vs. 91 of 158 [57.6%]; P = 0.002). Using marginal structural modeling, corticosteroid therapy was not significantly associated with 90-day mortality (adjusted odds ratio, 0.75; 95% confidence interval, 0.52-1.07; P = 0.12) but was associated with delay in MERS coronavirus RNA clearance (adjusted hazard ratio, 0.35; 95% CI, 0.17-0.72; P = 0.005).
CONCLUSIONS
Corticosteroid therapy in patients with MERS was not associated with a difference in mortality after adjustment for time-varying confounders but was associated with delayed MERS coronavirus RNA clearance. These findings highlight the challenges and importance of adjusting for baseline and time-varying confounders when estimating clinical effects of treatments using observational studies.
MeSH
Pub Type(s)
Journal Article
Multicenter Study
Language
eng
PubMed ID
29161116
Citation
Arabi, Yaseen M., et al. "Corticosteroid Therapy for Critically Ill Patients With Middle East Respiratory Syndrome." American Journal of Respiratory and Critical Care Medicine, vol. 197, no. 6, 2018, pp. 757-767.
Arabi YM, Mandourah Y, Al-Hameed F, et al. Corticosteroid Therapy for Critically Ill Patients with Middle East Respiratory Syndrome. Am J Respir Crit Care Med. 2018;197(6):757-767.
Arabi, Y. M., Mandourah, Y., Al-Hameed, F., Sindi, A. A., Almekhlafi, G. A., Hussein, M. A., ... Fowler, R. A. (2018). Corticosteroid Therapy for Critically Ill Patients with Middle East Respiratory Syndrome. American Journal of Respiratory and Critical Care Medicine, 197(6), pp. 757-767. doi:10.1164/rccm.201706-1172OC.
Arabi YM, et al. Corticosteroid Therapy for Critically Ill Patients With Middle East Respiratory Syndrome. Am J Respir Crit Care Med. 2018 03 15;197(6):757-767. PubMed PMID: 29161116.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR
T1 - Corticosteroid Therapy for Critically Ill Patients with Middle East Respiratory Syndrome.
AU - Arabi,Yaseen M,
AU - Mandourah,Yasser,
AU - Al-Hameed,Fahad,
AU - Sindi,Anees A,
AU - Almekhlafi,Ghaleb A,
AU - Hussein,Mohamed A,
AU - Jose,Jesna,
AU - Pinto,Ruxandra,
AU - Al-Omari,Awad,
AU - Kharaba,Ayman,
AU - Almotairi,Abdullah,
AU - Al Khatib,Kasim,
AU - Alraddadi,Basem,
AU - Shalhoub,Sarah,
AU - Abdulmomen,Ahmed,
AU - Qushmaq,Ismael,
AU - Mady,Ahmed,
AU - Solaiman,Othman,
AU - Al-Aithan,Abdulsalam M,
AU - Al-Raddadi,Rajaa,
AU - Ragab,Ahmed,
AU - Balkhy,Hanan H,
AU - Al Harthy,Abdulrahman,
AU - Deeb,Ahmad M,
AU - Al Mutairi,Hanan,
AU - Al-Dawood,Abdulaziz,
AU - Merson,Laura,
AU - Hayden,Frederick G,
AU - Fowler,Robert A,
AU - ,,
PY - 2017/11/22/pubmed
PY - 2019/8/23/medline
PY - 2017/11/22/entrez
KW - Saudi Arabia
KW - coronavirus
KW - corticosteroid
KW - pneumonia
KW - respiratory distress syndrome
SP - 757
EP - 767
JF - American journal of respiratory and critical care medicine
JO - Am. J. Respir. Crit. Care Med.
VL - 197
IS - 6
N2 - RATIONALE: Corticosteroid therapy is commonly used among critically ill patients with Middle East Respiratory Syndrome (MERS), but its impact on outcomes is uncertain. Analyses of observational studies often do not account for patients' clinical condition at the time of corticosteroid therapy initiation. OBJECTIVES: To investigate the association of corticosteroid therapy on mortality and on MERS coronavirus RNA clearance in critically ill patients with MERS. METHODS: ICU patients with MERs were included from 14 Saudi Arabian centers between September 2012 and October 2015. We performed marginal structural modeling to account for baseline and time-varying confounders. MEASUREMENTS AND MAIN RESULTS: Of 309 patients, 151 received corticosteroids. Corticosteroids were initiated at a median of 3.0 days (quartile 1 [Q1]-Q3, 1.0-7.0) from ICU admission. Patients who received corticosteroids were more likely to receive invasive ventilation (141 of 151 [93.4%] vs. 121 of 158 [76.6%]; P < 0.0001) and had higher 90-day crude mortality (112 of 151 [74.2%] vs. 91 of 158 [57.6%]; P = 0.002). Using marginal structural modeling, corticosteroid therapy was not significantly associated with 90-day mortality (adjusted odds ratio, 0.75; 95% confidence interval, 0.52-1.07; P = 0.12) but was associated with delay in MERS coronavirus RNA clearance (adjusted hazard ratio, 0.35; 95% CI, 0.17-0.72; P = 0.005). CONCLUSIONS: Corticosteroid therapy in patients with MERS was not associated with a difference in mortality after adjustment for time-varying confounders but was associated with delayed MERS coronavirus RNA clearance. These findings highlight the challenges and importance of adjusting for baseline and time-varying confounders when estimating clinical effects of treatments using observational studies.
SN - 1535-4970
UR - https://www.unboundmedicine.com/medline/citation/29161116/full_citation
L2 - http://www.atsjournals.org/doi/full/10.1164/rccm.201706-1172OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed
DB - PRIME
DP - Unbound Medicine
ER -
