Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study
Moreno, Gerard ; Rodríguez, Alejandro ; Reyes, Luis F. ; Gomez, Josep ; Sole-Violan, Jordi ; Díaz, Emili ; Bodí, María ; Trefler, Sandra ; Guardiola, Juan ; Yébenes, Juan C. ; Soriano, Alex ; Garnacho-Montero, José ; Socias, Lorenzo ; del Valle Ortíz, María ; Correig, Eudald ; Marín-Corral, Judith ; Vallverdú-Vidal, Montserrat ; Restrepo, Marcos I. ; Torres, Antoni ; Martín-Loeches, Ignacio ; Cobo, Pedro ; Martins, Javier ; Carbayo, Cecilia ; Robles-Musso, Emilio ; Cárdenas, Antonio [...] Mostrar todos los autores (65)
Resumen: 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.
Idioma: Inglés
DOI: 10.1007/s00134-018-5332-4
Año: 2018
Publicado en: INTENSIVE CARE MEDICINE 44, 9 (2018), 1470-1482
ISSN: 0342-4642
Factor impacto JCR: 18.967 (2018)
Categ. JCR: CRITICAL CARE MEDICINE rank: 2 / 33 = 0.061 (2018) - Q1 - T1
Factor impacto SCIMAGO: 3.654 - Critical Care and Intensive Care Medicine (Q1)
Tipo y forma: Artículo (PostPrint)
Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)
Derechos reservados por el editor de la revista
Exportado de SIDERAL (2025-03-10-12:55:45)
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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.
Idioma: Inglés
DOI: 10.1007/s00134-018-5332-4
Año: 2018
Publicado en: INTENSIVE CARE MEDICINE 44, 9 (2018), 1470-1482
ISSN: 0342-4642
Factor impacto JCR: 18.967 (2018)
Categ. JCR: CRITICAL CARE MEDICINE rank: 2 / 33 = 0.061 (2018) - Q1 - T1
Factor impacto SCIMAGO: 3.654 - Critical Care and Intensive Care Medicine (Q1)
Tipo y forma: Artículo (PostPrint)
Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)
Derechos reservados por el editor de la revistaExportado de SIDERAL (2025-03-10-12:55:45)
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