Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study

Saura, Ouriel; Rouzé, Anahita; Martin Loeches, Ignacio; Povoa, Pedro; Kreitmann, Louis; Torres Martí, Antoni; Metzelard, Matthieu; Du Cheyron, Damien; Lambiotte, Fabien; Tamion, Fabienne; Labruyere, Marie; Boulle Geronimi, Claire; Luyt, Charles-Edouard; Nyunga, Martine; Pouly, Olivier; Thille, Arnaud Wilfrid; Megarbane, Bruno; Saade, Anastasia; Magira, Eleni; Llitjos, Jean-François; Ioannidou, Iliana; Pierre, Alexandre; Reignier, Jean; Garot, Denis; Baudel, Jean-Luc; Voiriot, Guillaume; Plantefeve, Gaëtan; Morawiec, Elise; Asfar, Pierre; Boyer, Alexandre; Mekontso-Dessap, Armand; Bardaka, Fotini; Diaz, Emili; Vinsonneau, Christophe; Floch, Pierre-Edouard; Weiss, Nicolas; Ceccato, Adrian; Artigas, Antonio; Nora, David; Duhamel, Alain; Labreuche, Julien; Nseir, Saad; coVAPid Study Group

Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study

Background: Ventilator-associated pneumonia (VAP) is common in patients with severe SARS-CoV-2 pneumonia. The aim of this ancillary analysis of the coVAPid multicenter observational retrospective study is to assess the relationship between adjuvant corticosteroid use and the incidence of VAP. Method...

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Autores:	Saura, Ouriel, Rouzé, Anahita, Martin Loeches, Ignacio, Povoa, Pedro, Kreitmann, Louis, Torres Martí, Antoni, Metzelard, Matthieu, Du Cheyron, Damien, Lambiotte, Fabien, Tamion, Fabienne, Labruyere, Marie, Boulle Geronimi, Claire, Luyt, Charles-Edouard, Nyunga, Martine, Pouly, Olivier, Thille, Arnaud Wilfrid, Megarbane, Bruno, Saade, Anastasia, Magira, Eleni, Llitjos, Jean-François, Ioannidou, Iliana, Pierre, Alexandre, Reignier, Jean, Garot, Denis, Baudel, Jean-Luc, Voiriot, Guillaume, Plantefeve, Gaëtan, Morawiec, Elise, Asfar, Pierre, Boyer, Alexandre, Mekontso-Dessap, Armand, Bardaka, Fotini, Diaz, Emili, Vinsonneau, Christophe, Floch, Pierre-Edouard, Weiss, Nicolas, Ceccato, Adrian, Artigas, Antonio, Nora, David, Duhamel, Alain, Labreuche, Julien, Nseir, Saad, coVAPid Study Group
Tipo de recurso:	artículo
Estado:	Versión publicada
Fecha de publicación:	2023
País:	España
Institución:	Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:	Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:	oai:recercat.cat:2445/196208
Acceso en línea:	https://hdl.handle.net/2445/196208
Access Level:	acceso abierto
Palabra clave:	COVID-19 Pneumònia Corticosteroides Infeccions respiratòries Respiració artificial Respiradors Pneumonia Adrenocortical hormones Respiratory infections Artificial respiration Respirators

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spelling	Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter studySaura, OurielRouzé, AnahitaMartin Loeches, IgnacioPovoa, PedroKreitmann, LouisTorres Martí, AntoniMetzelard, MatthieuDu Cheyron, DamienLambiotte, FabienTamion, FabienneLabruyere, MarieBoulle Geronimi, ClaireLuyt, Charles-EdouardNyunga, MartinePouly, OlivierThille, Arnaud WilfridMegarbane, BrunoSaade, AnastasiaMagira, EleniLlitjos, Jean-FrançoisIoannidou, IlianaPierre, AlexandreReignier, JeanGarot, DenisBaudel, Jean-LucVoiriot, GuillaumePlantefeve, GaëtanMorawiec, EliseAsfar, PierreBoyer, AlexandreMekontso-Dessap, ArmandBardaka, FotiniDiaz, EmiliVinsonneau, ChristopheFloch, Pierre-EdouardWeiss, NicolasCeccato, AdrianArtigas, AntonioNora, DavidDuhamel, AlainLabreuche, JulienNseir, SaadcoVAPid Study GroupCOVID-19PneumòniaCorticosteroidesInfeccions respiratòriesRespiració artificialRespiradorsCOVID-19PneumoniaAdrenocortical hormonesRespiratory infectionsArtificial respirationRespiratorsBackground: Ventilator-associated pneumonia (VAP) is common in patients with severe SARS-CoV-2 pneumonia. The aim of this ancillary analysis of the coVAPid multicenter observational retrospective study is to assess the relationship between adjuvant corticosteroid use and the incidence of VAP. Methods: Planned ancillary analysis of a multicenter retrospective European cohort in 36 ICUs. Adult patients receiving invasive mechanical ventilation for more than 48 h for SARS-CoV-2 pneumonia were consecutively included between February and May 2020. VAP diagnosis required strict definition with clinical, radiological and quantitative microbiological confirmation. We assessed the association of VAP with corticosteroid treatment using univariate and multivariate cause-specific Cox's proportional hazard models with adjustment on pre-specified confounders. Results: Among the 545 included patients, 191 (35%) received corticosteroids. The proportional hazard assumption for the effect of corticosteroids on the incidence of VAP could not be accepted, indicating that this effect varied during ICU stay. We found a non-significant lower risk of VAP for corticosteroid-treated patients during the first days in the ICU and an increased risk for longer ICU stay. By modeling the effect of corticosteroids with time-dependent coefficients, the association between corticosteroids and the incidence of VAP was not significant (overall effect p = 0.082), with time-dependent hazard ratios (95% confidence interval) of 0.47 (0.17-1.31) at day 2, 0.95 (0.63-1.42) at day 7, 1.48 (1.01-2.16) at day 14 and 1.94 (1.09-3.46) at day 21. Conclusions: No significant association was found between adjuvant corticosteroid treatment and the incidence of VAP, although a time-varying effect of corticosteroids was identified along the 28-day follow-up.BioMed Central2023202320232023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion11 p.application/pdfhttps://hdl.handle.net/2445/196208Articles publicats en revistes (Medicina)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: https://doi.org/10.1186/s13054-022-04170-2Critical Care, 2023, vol. 26, num. 1, p. 292https://doi.org/10.1186/s13054-022-04170-2cc-by (c) Saura, Ouriel et al., 2022https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:2445/1962082026-05-29T05:05:01Z
dc.title.none.fl_str_mv	Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study
title	Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study
spellingShingle	Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study Saura, Ouriel COVID-19 Pneumònia Corticosteroides Infeccions respiratòries Respiració artificial Respiradors COVID-19 Pneumonia Adrenocortical hormones Respiratory infections Artificial respiration Respirators
title_short	Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study
title_full	Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study
title_fullStr	Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study
title_full_unstemmed	Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study
title_sort	Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study
dc.creator.none.fl_str_mv	Saura, Ouriel Rouzé, Anahita Martin Loeches, Ignacio Povoa, Pedro Kreitmann, Louis Torres Martí, Antoni Metzelard, Matthieu Du Cheyron, Damien Lambiotte, Fabien Tamion, Fabienne Labruyere, Marie Boulle Geronimi, Claire Luyt, Charles-Edouard Nyunga, Martine Pouly, Olivier Thille, Arnaud Wilfrid Megarbane, Bruno Saade, Anastasia Magira, Eleni Llitjos, Jean-François Ioannidou, Iliana Pierre, Alexandre Reignier, Jean Garot, Denis Baudel, Jean-Luc Voiriot, Guillaume Plantefeve, Gaëtan Morawiec, Elise Asfar, Pierre Boyer, Alexandre Mekontso-Dessap, Armand Bardaka, Fotini Diaz, Emili Vinsonneau, Christophe Floch, Pierre-Edouard Weiss, Nicolas Ceccato, Adrian Artigas, Antonio Nora, David Duhamel, Alain Labreuche, Julien Nseir, Saad coVAPid Study Group
author	Saura, Ouriel
author_facet	Saura, Ouriel Rouzé, Anahita Martin Loeches, Ignacio Povoa, Pedro Kreitmann, Louis Torres Martí, Antoni Metzelard, Matthieu Du Cheyron, Damien Lambiotte, Fabien Tamion, Fabienne Labruyere, Marie Boulle Geronimi, Claire Luyt, Charles-Edouard Nyunga, Martine Pouly, Olivier Thille, Arnaud Wilfrid Megarbane, Bruno Saade, Anastasia Magira, Eleni Llitjos, Jean-François Ioannidou, Iliana Pierre, Alexandre Reignier, Jean Garot, Denis Baudel, Jean-Luc Voiriot, Guillaume Plantefeve, Gaëtan Morawiec, Elise Asfar, Pierre Boyer, Alexandre Mekontso-Dessap, Armand Bardaka, Fotini Diaz, Emili Vinsonneau, Christophe Floch, Pierre-Edouard Weiss, Nicolas Ceccato, Adrian Artigas, Antonio Nora, David Duhamel, Alain Labreuche, Julien Nseir, Saad coVAPid Study Group
author_role	author
author2	Rouzé, Anahita Martin Loeches, Ignacio Povoa, Pedro Kreitmann, Louis Torres Martí, Antoni Metzelard, Matthieu Du Cheyron, Damien Lambiotte, Fabien Tamion, Fabienne Labruyere, Marie Boulle Geronimi, Claire Luyt, Charles-Edouard Nyunga, Martine Pouly, Olivier Thille, Arnaud Wilfrid Megarbane, Bruno Saade, Anastasia Magira, Eleni Llitjos, Jean-François Ioannidou, Iliana Pierre, Alexandre Reignier, Jean Garot, Denis Baudel, Jean-Luc Voiriot, Guillaume Plantefeve, Gaëtan Morawiec, Elise Asfar, Pierre Boyer, Alexandre Mekontso-Dessap, Armand Bardaka, Fotini Diaz, Emili Vinsonneau, Christophe Floch, Pierre-Edouard Weiss, Nicolas Ceccato, Adrian Artigas, Antonio Nora, David Duhamel, Alain Labreuche, Julien Nseir, Saad coVAPid Study Group
author2_role	author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author
dc.subject.none.fl_str_mv	COVID-19 Pneumònia Corticosteroides Infeccions respiratòries Respiració artificial Respiradors COVID-19 Pneumonia Adrenocortical hormones Respiratory infections Artificial respiration Respirators
topic	COVID-19 Pneumònia Corticosteroides Infeccions respiratòries Respiració artificial Respiradors COVID-19 Pneumonia Adrenocortical hormones Respiratory infections Artificial respiration Respirators
description	Background: Ventilator-associated pneumonia (VAP) is common in patients with severe SARS-CoV-2 pneumonia. The aim of this ancillary analysis of the coVAPid multicenter observational retrospective study is to assess the relationship between adjuvant corticosteroid use and the incidence of VAP. Methods: Planned ancillary analysis of a multicenter retrospective European cohort in 36 ICUs. Adult patients receiving invasive mechanical ventilation for more than 48 h for SARS-CoV-2 pneumonia were consecutively included between February and May 2020. VAP diagnosis required strict definition with clinical, radiological and quantitative microbiological confirmation. We assessed the association of VAP with corticosteroid treatment using univariate and multivariate cause-specific Cox's proportional hazard models with adjustment on pre-specified confounders. Results: Among the 545 included patients, 191 (35%) received corticosteroids. The proportional hazard assumption for the effect of corticosteroids on the incidence of VAP could not be accepted, indicating that this effect varied during ICU stay. We found a non-significant lower risk of VAP for corticosteroid-treated patients during the first days in the ICU and an increased risk for longer ICU stay. By modeling the effect of corticosteroids with time-dependent coefficients, the association between corticosteroids and the incidence of VAP was not significant (overall effect p = 0.082), with time-dependent hazard ratios (95% confidence interval) of 0.47 (0.17-1.31) at day 2, 0.95 (0.63-1.42) at day 7, 1.48 (1.01-2.16) at day 14 and 1.94 (1.09-3.46) at day 21. Conclusions: No significant association was found between adjuvant corticosteroid treatment and the incidence of VAP, although a time-varying effect of corticosteroids was identified along the 28-day follow-up.
publishDate	2023
dc.date.none.fl_str_mv	2023 2023 2023 2023
dc.type.none.fl_str_mv	info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion
format	article
status_str	publishedVersion
dc.identifier.none.fl_str_mv	https://hdl.handle.net/2445/196208
url	https://hdl.handle.net/2445/196208
dc.language.none.fl_str_mv	Inglés
language_invalid_str_mv	Inglés
dc.relation.none.fl_str_mv	Reproducció del document publicat a: https://doi.org/10.1186/s13054-022-04170-2 Critical Care, 2023, vol. 26, num. 1, p. 292 https://doi.org/10.1186/s13054-022-04170-2
dc.rights.none.fl_str_mv	cc-by (c) Saura, Ouriel et al., 2022 https://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess
rights_invalid_str_mv	cc-by (c) Saura, Ouriel et al., 2022 https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv	openAccess
dc.format.none.fl_str_mv	11 p. application/pdf
dc.publisher.none.fl_str_mv	BioMed Central
publisher.none.fl_str_mv	BioMed Central
dc.source.none.fl_str_mv	Articles publicats en revistes (Medicina) reponame:Recercat. Dipósit de la Recerca de Catalunya instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str	Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str	Recercat. Dipósit de la Recerca de Catalunya
collection	Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study

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