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Randomized Controlled Trial
. 2015 Dec 2:5:17654.
doi: 10.1038/srep17654.

The effectiveness of Corticosteroids on mortality in patients with acute respiratory distress syndrome or acute lung injury: a secondary analysis

Zhongheng Zhang  1 , Lin Chen  1 , Hongying Ni  1
Affiliations
Randomized Controlled Trial

The effectiveness of Corticosteroids on mortality in patients with acute respiratory distress syndrome or acute lung injury: a secondary analysis

Zhongheng Zhang et al. Sci Rep. .

Abstract

The development of acute respiratory distress syndrome (ARDS) is associated with dys-regulated inflammation. Since corticosteroids are potent anti-inflammatory drugs, they are thought to be beneficial for ARDS patients. The study aimed to investigate the effectiveness of corticosteroids on mortality outcome in ARDS patients. The study was a secondary analysis of a prospective randomized controlled trial (NCT00979121). ARDS patients with invasive mechanical ventilation were enrolled. Corticosteroids use was defined as IV or PO administration of corticosteroids totaling more than 20 mg methylprednisolone equivalents during one calendar day. Missing data were handled using multiple imputation technique. Multivariable model was built to adjust for confounding covariates. A total of 745 patients were enrolled, including 540 survivors and 205 non-survivors. Patients in the non-survivor group were more likely to use corticosteroids (38% vs. 29.8%; p = 0.032). After adjustment for other potential confounders, corticosteroids showed no statistically significant effect on mortality outcome (OR: 1.18; 95% CI: 0.81-1.71). Furthermore, we investigated the interaction between corticosteroid use and variables of vasopressor and PaO2. The result showed that there was no significant interaction. In conclusion, the study failed to identify any beneficial effects of corticosteroids on mortality outcome in patients with ARDS.

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Figures

Figure 1
Figure 1. Graphical presentation of patients receiving corticosteroids, those without receiving corticosteroids and those with missing data.
The proportion of patients with missing data increased from day 1 to day 7, which was attributable to ICU discharge or death (the end of follow up).
Figure 2
Figure 2. Four diagnostic plots to describe discrimination in a model fit with an area under operating characteristics curve of 0.71.
The plot of jittered outcome versus estimated probability of death showed that survivors were morel likely to appear below 0.4. However, non-survivors were normally distributed with the mean value at somewhere between 0.3 and 0.4. The Hosmer-Lemeshow chi2 statistic was 4.89 (p  =  0.7689).
Figure 3
Figure 3. Receiver operating characteristics curve showing the discrimination power of the logistic regression model in predicting corticosteroid use.
The area under curve was 0.71.
Figure 4
Figure 4. Distribution of propensity scores.
All treated patients were matched to the untreated patients.
See this image and copyright information in PMC

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