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Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study

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  • Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study

    Intensive Care Med. 2018 Aug 3. doi: 10.1007/s00134-018-5332-4. [Epub ahead of print]
    Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study.

    Moreno G1, Rodríguez A2, Reyes LF3, Gomez J1, Sole-Violan J4, Díaz E5, Bodí M1, Trefler S1, Guardiola J6, Yébenes JC7, Soriano A8, Garnacho-Montero J9, Socias L10, Del Valle Ortíz M11, Correig E12, Marín-Corral J13, Vallverdú-Vidal M14, Restrepo MI15, Torres A16, Martín-Loeches I17; on Behalf GETGAG Study Group.
    Collaborators (450)

    Author information

    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.


    KEYWORDS:

    Corticosteroids; ICU; Influenza; Mortality; Pneumonia

    PMID: 30074052 DOI: 10.1007/s00134-018-5332-4
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