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Observational Study
. 2018 Sep;44(9):1470-1482.
doi: 10.1007/s00134-018-5332-4. Epub 2018 Aug 3.

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

Gerard Moreno  1 , Alejandro Rodríguez  2 , Luis F Reyes  3   4 , Josep Gomez  1 , Jordi Sole-Violan  5 , Emili Díaz  6 , María Bodí  1 , Sandra Trefler  1 , Juan Guardiola  7 , Juan C Yébenes  8 , Alex Soriano  9 , José Garnacho-Montero  10 , Lorenzo Socias  11 , María Del Valle Ortíz  12 , Eudald Correig  13 , Judith Marín-Corral  14 , Montserrat Vallverdú-Vidal  15 , Marcos I Restrepo  16 , Antoni Torres  17 , Ignacio Martín-Loeches  18 ; GETGAG Study Group
Collaborators, Affiliations
Observational Study

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

Gerard Moreno et al. Intensive Care Med. 2018 Sep.

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.

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Conflict of interest statement

All named authors declare that they have no conflicting interests.

Figures

Fig. 1
Fig. 1
Flowchart of all excluded and included patients
Fig. 2
Fig. 2
Subgroup analysis of ICU mortality according to corticosteroid treatment. APACHE II Acute Physiology and Chronic Health Evaluation II score, MV mechanical ventilation, SOFA Sequential Organ Failure Assessment, CRP C-reactive protein, COPD chronic obstructive pulmonary disease
Fig. 3
Fig. 3
Cox regression survival plot during ICU admission according to corticosteroid therapy
Fig. 4
Fig. 4
Cumulative incidence function of ICU death and being discharged alive according to corticosteroid therapy
See this image and copyright information in PMC

Comment in

References

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