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

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 pneum...

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Detalles Bibliográficos
Autores: 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, Fierro, Javier, Ocaña Fernández, Dolores, Sierra, Rafael, Huertos, Mª Jesús, Carmona Pérez, Mª Luz, Pozo Laderas, Juan Carlos, Guerrero, R., Robles, Juan Carlos, Echevarría León, Melissa, Bermejo Gómez, Alberto, Márquez, Enrique, Rodríguez-Carvajal, Manuel, Estella, Ángel, Pomares, José, Ballesteros, José Luis, Moreno Romero, Olga, Fernández, Yolanda, Lobato, Francisco, Prieto, José F., Albofedo-Sánchez, José, Martínez, Pilar, de la Torre, María Victoria, Nieto, María, Camara Sola, Estefanía, Díaz Castellanos, Miguel Angel, Sevilla Soler, Guillermo, Ortiz Leyba, Carlos, Hinojosa, Rafael, Fernández, Esteban, Loza, Ana, León, Cristóbal, González López, Samuel, Arenzana, Angel, Navarrete, Inés, Zaheri Beryanaki, Medhi, Sánchez, Ignacio, Pérez Alé, Manuel, Poullet Brea, Ana Mª, Machado Casas, Juan Francisco, Serón, Carlos
Tipo de recurso: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2018
País:España
Institución:Universidad de Zaragoza
Repositorio:Zaguán. Repositorio Digital de la Universidad de Zaragoza
OAI Identifier:oai:dnet:zaguan______::0f4bb355b101ad45f17b68aae2ebe75c
Acceso en línea:http://zaguan.unizar.es/record/151447
Access Level:acceso abierto
Descripción
Sumario: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.

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