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Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study.
Intensive Care Med. 2018 Sep; 44(9):1470-1482.IC

Abstract

PURPOSE

To determine clinical predictors associated with corticosteroid administration and its association with ICU mortality in critically ill patients with severe influenza pneumonia.

METHODS

Secondary analysis of a prospective cohort study of critically ill patients with confirmed influenza pneumonia admitted to 148 ICUs in Spain between June 2009 and April 2014. Patients who received corticosteroid treatment for causes other than viral pneumonia (e.g., refractory septic shock and asthma or chronic obstructive pulmonary disease [COPD] exacerbation) were excluded. Patients with corticosteroid therapy were compared with those without corticosteroid therapy. We use a propensity score (PS) matching analysis to reduce confounding factors. The primary outcome was ICU mortality. Cox proportional hazards and competing risks analysis was performed to assess the impact of corticosteroids on ICU mortality.

RESULTS

A total of 1846 patients with primary influenza pneumonia were enrolled. Corticosteroids were administered in 604 (32.7%) patients, with methylprednisolone the most frequently used corticosteroid (578/604 [95.7%]). The median daily dose was equivalent to 80 mg of methylprednisolone (IQR 60-120) for a median duration of 7 days (IQR 5-10). Asthma, COPD, hematological disease, and the need for mechanical ventilation were independently associated with corticosteroid use. Crude ICU mortality was higher in patients who received corticosteroids (27.5%) than in patients who did not receive corticosteroids (18.8%, p < 0.001). After PS matching, corticosteroid use was associated with ICU mortality in the Cox (HR = 1.32 [95% CI 1.08-1.60], p < 0.006) and competing risks analysis (SHR = 1.37 [95% CI 1.12-1.68], p = 0.001).

CONCLUSION

Administration of corticosteroids in patients with severe influenza pneumonia is associated with increased ICU mortality, and these agents should not be used as co-adjuvant therapy.

Authors+Show Affiliations

Critical Care Department URV/IISPV/CIBERES, Hospital Universitari de Tarragona Joan XXIII, Mallafré Guasch 4, 43007, Tarragona, Spain.Critical Care Department URV/IISPV/CIBERES, Hospital Universitari de Tarragona Joan XXIII, Mallafré Guasch 4, 43007, Tarragona, Spain. ahr1161@yahoo.es.Department of Microbiology, Universidad de La Sabana, Chia, Colombia. Department of Critical Care Medicine, Clinica Universidad de La Sabana, Chia, Colombia.Critical Care Department URV/IISPV/CIBERES, Hospital Universitari de Tarragona Joan XXIII, Mallafré Guasch 4, 43007, Tarragona, Spain.Critical Care Department, Hospital Dr. Negrín Gran Canaria, Las Palmas, Gran Canaria, Spain.Critical Care Department/CIBERES, Hospital Parc Taulí, Sabadell, Spain.Critical Care Department URV/IISPV/CIBERES, Hospital Universitari de Tarragona Joan XXIII, Mallafré Guasch 4, 43007, Tarragona, Spain.Critical Care Department URV/IISPV/CIBERES, Hospital Universitari de Tarragona Joan XXIII, Mallafré Guasch 4, 43007, Tarragona, Spain.Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville and Robley Rex VA Medical Center, Louisville, KY, USA.Critical Care Department, Hospital de Mataró, Mataró, Spain.Hospital Clínic Infectious Diseases, Hospital Clínic, Barcelona, Spain.Critical Care Department, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain.Critical Care Department, Hospital Son Llàtzer, Palma, Spain.Critical Care Department, Hospital Universitario de Burgos, Burgos, Spain.Departamento de Bioestadística, Universitat Rovira I Virgili, Tarragona, Spain.Critical Care Department, Hospital Del Mar, Research Group in Critical Disorders (GREPAC), IMIM, Barcelona, Spain.Critical Care Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain.South Texas Veterans Health Care System, University of Texas Health Sciences at San Antonio, San Antonio, Texas, USA.Hospital Clínic de Barcelona, Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clínic del Tórax/CIBERES, Barcelona, Spain.Department of Anaesthesia and Critical Care, St James ́s University Hospital, Trinity Centre for Health Sciences, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Ireland.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

30074052

Citation

Moreno, Gerard, et al. "Corticosteroid Treatment in Critically Ill Patients With Severe Influenza Pneumonia: a Propensity Score Matching Study." Intensive Care Medicine, vol. 44, no. 9, 2018, pp. 1470-1482.
Moreno G, Rodríguez A, Reyes LF, et al. Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study. Intensive Care Med. 2018;44(9):1470-1482.
Moreno, G., Rodríguez, A., Reyes, L. F., Gomez, J., Sole-Violan, J., Díaz, E., Bodí, M., Trefler, S., Guardiola, J., Yébenes, J. C., Soriano, A., Garnacho-Montero, J., Socias, L., Del Valle Ortíz, M., Correig, E., Marín-Corral, J., Vallverdú-Vidal, M., Restrepo, M. I., Torres, A., & Martín-Loeches, I. (2018). Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study. Intensive Care Medicine, 44(9), 1470-1482. https://doi.org/10.1007/s00134-018-5332-4
Moreno G, et al. Corticosteroid Treatment in Critically Ill Patients With Severe Influenza Pneumonia: a Propensity Score Matching Study. Intensive Care Med. 2018;44(9):1470-1482. PubMed PMID: 30074052.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study. AU - Moreno,Gerard, AU - Rodríguez,Alejandro, AU - Reyes,Luis F, AU - Gomez,Josep, AU - Sole-Violan,Jordi, AU - Díaz,Emili, AU - Bodí,María, AU - Trefler,Sandra, AU - Guardiola,Juan, AU - Yébenes,Juan C, AU - Soriano,Alex, AU - Garnacho-Montero,José, AU - Socias,Lorenzo, AU - Del Valle Ortíz,María, AU - Correig,Eudald, AU - Marín-Corral,Judith, AU - Vallverdú-Vidal,Montserrat, AU - Restrepo,Marcos I, AU - Torres,Antoni, AU - Martín-Loeches,Ignacio, AU - ,, Y1 - 2018/08/03/ PY - 2018/03/12/received PY - 2018/07/21/accepted PY - 2018/8/4/pubmed PY - 2019/11/5/medline PY - 2018/8/4/entrez KW - Corticosteroids KW - ICU KW - Influenza KW - Mortality KW - Pneumonia SP - 1470 EP - 1482 JF - Intensive care medicine JO - Intensive Care Med VL - 44 IS - 9 N2 - PURPOSE: To determine clinical predictors associated with corticosteroid administration and its association with ICU mortality in critically ill patients with severe influenza pneumonia. METHODS: Secondary analysis of a prospective cohort study of critically ill patients with confirmed influenza pneumonia admitted to 148 ICUs in Spain between June 2009 and April 2014. Patients who received corticosteroid treatment for causes other than viral pneumonia (e.g., refractory septic shock and asthma or chronic obstructive pulmonary disease [COPD] exacerbation) were excluded. Patients with corticosteroid therapy were compared with those without corticosteroid therapy. We use a propensity score (PS) matching analysis to reduce confounding factors. The primary outcome was ICU mortality. Cox proportional hazards and competing risks analysis was performed to assess the impact of corticosteroids on ICU mortality. RESULTS: A total of 1846 patients with primary influenza pneumonia were enrolled. Corticosteroids were administered in 604 (32.7%) patients, with methylprednisolone the most frequently used corticosteroid (578/604 [95.7%]). The median daily dose was equivalent to 80 mg of methylprednisolone (IQR 60-120) for a median duration of 7 days (IQR 5-10). Asthma, COPD, hematological disease, and the need for mechanical ventilation were independently associated with corticosteroid use. Crude ICU mortality was higher in patients who received corticosteroids (27.5%) than in patients who did not receive corticosteroids (18.8%, p < 0.001). After PS matching, corticosteroid use was associated with ICU mortality in the Cox (HR = 1.32 [95% CI 1.08-1.60], p < 0.006) and competing risks analysis (SHR = 1.37 [95% CI 1.12-1.68], p = 0.001). CONCLUSION: Administration of corticosteroids in patients with severe influenza pneumonia is associated with increased ICU mortality, and these agents should not be used as co-adjuvant therapy. SN - 1432-1238 UR - https://www.unboundmedicine.com/medline/citation/30074052/Corticosteroid_treatment_in_critically_ill_patients_with_severe_influenza_pneumonia:_a_propensity_score_matching_study_ L2 - https://dx.doi.org/10.1007/s00134-018-5332-4 DB - PRIME DP - Unbound Medicine ER -