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

on behalf of the GETGAG Study Group

Research output: Contribution to journalArticle

12 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1470-1482
Number of pages13
JournalIntensive Care Medicine
Volume44
Issue number9
DOIs
StatePublished - Sep 1 2018

Fingerprint

Propensity Score
Critical Illness
Human Influenza
Pneumonia
Adrenal Cortex Hormones
Mortality
Therapeutics
Methylprednisolone
Chronic Obstructive Pulmonary Disease
Asthma
Viral Pneumonia
Hematologic Diseases
Septic Shock
Artificial Respiration
Spain
Disease Progression
Cohort Studies

Keywords

  • Corticosteroids
  • ICU
  • Influenza
  • Mortality
  • Pneumonia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Corticosteroid treatment in critically ill patients with severe influenza pneumonia : a propensity score matching study. / on behalf of the GETGAG Study Group.

In: Intensive Care Medicine, Vol. 44, No. 9, 01.09.2018, p. 1470-1482.

Research output: Contribution to journalArticle

@article{b076192b3de4490f826bbe173f07c087,
title = "Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study",
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",
author = "{on behalf of the GETGAG Study Group} and Gerard Moreno and Alejandro Rodr{\'i}guez and Reyes, {Luis F.} and Josep Gomez and Jordi Sole-Violan and Emili D{\'i}az and Mar{\'i}a Bod{\'i} and Sandra Trefler and Juan Guardiola and Y{\'e}benes, {Juan C.} and Alex Soriano and Jos{\'e} Garnacho-Montero and Lorenzo Socias and {del Valle Ort{\'i}z}, Mar{\'i}a and Eudald Correig and Judith Mar{\'i}n-Corral and Montserrat Vallverd{\'u}-Vidal and Marcos Restrepo and Antoni Torres and Ignacio Mart{\'i}n-Loeches and Pedro Cobo and Javier Martins and Cecilia Carbayo and Emilio Robles-Musso and Antonio C{\'a}rdenas and Javier Fierro and Fern{\'a}ndez, {Dolores Oca{\~n}a} and Rafael Sierra and Huertos, {Mª ªJ} and P{\'e}rez, {Mª Luz Carmona} and Laderas, {Juan Carlos Pozo} and R. Guerrero and Robles, {Juan Carlos} and Le{\'o}n, {Melissa Echevarr{\'i}a} and G{\'o}mez, {Alberto Bermejo} and Enrique M{\'a}rquez and Manuel Rodr{\'i}guez-Carvajal and {\'A}ngel Estella and Jos{\'e} Pomares and Ballesteros, {Jos{\'e} Luis} and Romero, {Olga Moreno} and Yolanda Fern{\'a}ndez and Francisco Lobato and Prieto, {Jos{\'e} F.} and Jos{\'e} Albofedo-S{\'a}nchez and Pilar Mart{\'i}nez and {de la Torre}, {Mar{\'i}a Victoria} and Mar{\'i}a Nieto and Sola, {Estefan{\'i}a Camara} and Castellanos, {Miguel Angel D{\'i}az}",
year = "2018",
month = "9",
day = "1",
doi = "10.1007/s00134-018-5332-4",
language = "English (US)",
volume = "44",
pages = "1470--1482",
journal = "Intensive Care Medicine",
issn = "0342-4642",
publisher = "Springer Verlag",
number = "9",

}

TY - JOUR

T1 - Corticosteroid treatment in critically ill patients with severe influenza pneumonia

T2 - a propensity score matching study

AU - on behalf of the GETGAG Study Group

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

AU - Torres, Antoni

AU - Martín-Loeches, Ignacio

AU - Cobo, Pedro

AU - Martins, Javier

AU - Carbayo, Cecilia

AU - Robles-Musso, Emilio

AU - Cárdenas, Antonio

AU - Fierro, Javier

AU - Fernández, Dolores Ocaña

AU - Sierra, Rafael

AU - Huertos, Mª ªJ

AU - Pérez, Mª Luz Carmona

AU - Laderas, Juan Carlos Pozo

AU - Guerrero, R.

AU - Robles, Juan Carlos

AU - León, Melissa Echevarría

AU - Gómez, Alberto Bermejo

AU - Márquez, Enrique

AU - Rodríguez-Carvajal, Manuel

AU - Estella, Ángel

AU - Pomares, José

AU - Ballesteros, José Luis

AU - Romero, Olga Moreno

AU - Fernández, Yolanda

AU - Lobato, Francisco

AU - Prieto, José F.

AU - Albofedo-Sánchez, José

AU - Martínez, Pilar

AU - de la Torre, María Victoria

AU - Nieto, María

AU - Sola, Estefanía Camara

AU - Castellanos, Miguel Angel Díaz

PY - 2018/9/1

Y1 - 2018/9/1

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.

AB - 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.

KW - Corticosteroids

KW - ICU

KW - Influenza

KW - Mortality

KW - Pneumonia

UR - http://www.scopus.com/inward/record.url?scp=85052101199&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052101199&partnerID=8YFLogxK

U2 - 10.1007/s00134-018-5332-4

DO - 10.1007/s00134-018-5332-4

M3 - Article

C2 - 30074052

AN - SCOPUS:85052101199

VL - 44

SP - 1470

EP - 1482

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 9

ER -