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 I.
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 Jesús
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
N1 - Publisher Copyright:
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM.
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
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U2 - 10.1007/s00134-018-5332-4
DO - 10.1007/s00134-018-5332-4
M3 - Article
C2 - 30074052
AN - SCOPUS:85052101199
SN - 0342-4642
VL - 44
SP - 1470
EP - 1482
JO - Intensive care medicine
JF - Intensive care medicine
IS - 9
ER -