Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection - PubMed (original) (raw)

Multicenter Study

doi: 10.1007/s00134-010-2078-z. Epub 2010 Nov 24.

T Lisboa, A Rhodes, R P Moreno, E Silva, C Sprung, J D Chiche, D Barahona, M Villabon, C Balasini, R M Pearse, R Matos, J Rello; ESICM H1N1 Registry Contributors

Collaborators, Affiliations

Multicenter Study

Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection

I Martin-Loeches et al. Intensive Care Med. 2011 Feb.

Abstract

Introduction: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial.

Methods: Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry.

Results: Two hundred twenty patients admitted to an intensive care unit (ICU) with completed outcome data were analyzed. Invasive mechanical ventilation was used in 155 (70.5%). Sixty-seven (30.5%) of the patients died in ICU and 75 (34.1%) whilst in hospital. One hundred twenty-six (57.3%) patients received corticosteroid therapy on admission to ICU. Patients who received corticosteroids were significantly older and were more likely to have coexisting asthma, chronic obstructive pulmonary disease (COPD), and chronic steroid use. These patients receiving corticosteroids had increased likelihood of developing hospital-acquired pneumonia (HAP) [26.2% versus 13.8%, p < 0.05; odds ratio (OR) 2.2, confidence interval (CI) 1.1-4.5]. Patients who received corticosteroids had significantly higher ICU mortality than patients who did not (46.0% versus 18.1%, p < 0.01; OR 3.8, CI 2.1-7.2). Cox regression analysis adjusted for severity and potential confounding factors identified that early use of corticosteroids was not significantly associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7-2.4, p = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0-4.8, p < 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed.

Conclusions: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections.

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Figures

Fig. 1

Fig. 1

Survival graph for patients with severe pandemic (H1N1)v influenza A infection with or without early corticosteroid therapy on ICU admission (censored at 60 days)

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