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Observational Study
. 2022 Sep 27;26(1):292.
doi: 10.1186/s13054-022-04170-2.

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

Ouriel Saura  1 , Anahita Rouzé  1   2 , Ignacio Martin-Loeches  3   4   5 , Pedro Povoa  6   7   8 , Louis Kreitmann  9 , Antoni Torres  10 , Matthieu Metzelard  11 , Damien Du Cheyron  12 , Fabien Lambiotte  13 , Fabienne Tamion  14 , Marie Labruyere  15 , Claire Boulle Geronimi  16 , Charles-Edouard Luyt  17 , Martine Nyunga  18 , Olivier Pouly  19 , Arnaud W Thille  20 , Bruno Megarbane  21 , Anastasia Saade  22 , Eleni Magira  23 , Jean-François Llitjos  24 , Iliana Ioannidou  25 , Alexandre Pierre  26 , Jean Reignier  27 , Denis Garot  28 , Jean-Luc Baudel  29 , Guillaume Voiriot  30 , Gaëtan Plantefeve  31 , Elise Morawiec  32   33 , Pierre Asfar  34 , Alexandre Boyer  35 , Armand Mekontso-Dessap  36   37   38 , Fotini Bardaka  39 , Emili Diaz  40   41 , Christophe Vinsonneau  42 , Pierre-Edouard Floch  43 , Nicolas Weiss  44   45   46 , Adrian Ceccato  47 , Antonio Artigas  48 , David Nora  6 , Alain Duhamel  49   50 , Julien Labreuche  50 , Saad Nseir  51   52 ; coVAPid Study Group
Collaborators, Affiliations
Observational Study

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

Ouriel Saura et al. Crit Care. .

Abstract

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.

Keywords: COVID-19; Corticosteroids; SARS-CoV-2; Ventilator-associated lower respiratory tract infections.

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Conflict of interest statement

AR received personal fees from Maat Pharma, and IML received personal fees from MSD and Gilead. AA received personal fees from Lilly Foundation and grants from Grifols and Fisher & Paykel. CEL received personal fees from Bayer, Merck, Aerogen, bioMérieux, ThermoFisher Brahms and Carmat. SN received personal fees from MSD, Bio Rad, bioMérieux, Gilead, Fisher & Paykel and Pfizer. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flowchart
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