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. 2022 Jul;14(7):2511-2521.
doi: 10.21037/jtd-21-890.

Efficacy of low-dose corticosteroids in patients with acute respiratory distress syndrome: a prospective observational study

Ruoyang Zhang #  1   2   3 , Xu Huang #  2   3 , Haining Lu #  4 , Guohui Fan  2   3   5 , Ying Cai  2   3 , Ye Tian  2   3 , Jingen Xia  2   3 , Wang Deng  6 , Daoxin Wang  6 , Junlu Li  7 , Shilei Wang  7 , Lihua Xing  7 , Shaohua Liu  8 , Tongwen Sun  8 , Dawei Wu  4 , Qingyuan Zhan  1   2   3 , Chen Wang  1   2   3 ; CHARDSnet group*; CHARDSnet group
Collaborators, Affiliations

Efficacy of low-dose corticosteroids in patients with acute respiratory distress syndrome: a prospective observational study

Ruoyang Zhang et al. J Thorac Dis. 2022 Jul.

Abstract

Background: There is still no agreement on whether corticosteroids can reduce mortality in patients with acute respiratory distress syndrome (ARDS). The aim of this study was to investigate the efficacy of low-dose corticosteroid administration in patients with ARDS.

Methods: A prospective observational study of patients with ARDS in 17 hospitals in China was performed between March 2016 and February 2018. Propensity score matching was performed to adjust for differences in baseline characteristics between different groups. The effects of corticosteroids were assessed by using the Kaplan-Meier method and a multivariate Cox regression.

Results: A total of 527 ARDS patients were enrolled in the study. Sixty-five patients (12.3%) were administered low-dose (methylprednisolone ≤1 mg·kg-1·d-1) corticosteroids. The median dose was equivalent to 0.67 (0.57-0.81) mg/kg methylprednisolone for a median duration of 10 days. The control group included 224 patients (42.5%) who had never receive corticosteroids. In the matched sample, the hospital mortality rates in the low-dose (n=40) and control groups (n=80) were 27.5% and 42.5% (P=0.110), respectively. The length of hospital stay was significantly longer in the low-dose corticosteroid group than in the control group (24.0 vs. 17.0, P=0.002), and the multivariate Cox regression analysis suggested that the low-dose group had a significantly lower risk of death than the control group (HR: 0.48; 95% CI: 0.24-0.97; P=0.040).

Conclusions: The administration of low-dose corticosteroids may reduce mortality in patients with ARDS.

Keywords: Acute respiratory distress syndrome (ARDS); corticosteroid; mortality.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-21-890/coif). All authors report funding from Beijing Municipal Science & Technology Commission, National Natural Science Foundation, and Chinese Academy of Medical Sciences.

Figures

Figure 1
Figure 1
Flowchart of patient screening and enrolment. P/F, PaO2/FiO2; ARDS, acute respiratory distress syndrome; AECOPD, acute exacerbations of chronic obstructive pulmonary disease; AEIPF, acute exacerbation of idiopathic pulmonary fibrosis; NPPV, non-invasive positive pressure ventilation; IPPV, invasive positive pressure ventilation.
Figure 2
Figure 2
The Kaplan-Meier analysis shows 30-day mortality between the two groups in the matched sample (A) and original sample (B).
Figure 3
Figure 3
Univariate Cox regression analysis for factors associated with hospital mortality in matched sample. SOFA, Sequential Organ Failure Assessment; ARDS, acute respiratory distress syndrome.
Figure 4
Figure 4
Multivariate Cox regression analysis for factors associated with hospital mortality in matched sample. SOFA, Sequential Organ Failure Assessment; ARDS, acute respiratory distress syndrome.
Figure 5
Figure 5
The Kaplan-Meier analysis showed that there was no significant difference in 30-day nosocomial infection between the two groups in the matched sample (A) and original sample (B).
See this image and copyright information in PMC

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