Impact of corticosteroid treatment on clinical outcomes of influenza-associated ARDS: a nationwide multicenter study
Journal
Annals of Intensive Care
Journal Volume
10
Journal Issue
1
Date Issued
2020
Author(s)
Tsai M.-J.
Yang K.-Y.
Chan M.-C.
Kao K.-C.
Perng W.-C.
Wu C.-L.
Liang S.-J.
Fang W.-F.
Tsai J.-R.
Chang W.-A.
Chen W.-C.
Hu H.-C.
Lin C.-Y.
Chao W.-C.
Sheu C.-C.
for Taiwan Severe Influenza Research Consortium (TSIRC) Investigators
Abstract
Background: Corticosteroid treatment has been widely used in the treatment of septic shock, influenza, and ARDS, although some previous studies discourage its use in severe influenza patients. This multicenter retrospective cohort study conducted in the intensive care units (ICUs) of eight medical centers across Taiwan aims to determine the real-world status of corticosteroid treatment in patients with influenza-associated acute respiratory distress syndrome (ARDS) and its impact on clinical outcomes. Between October 2015 and March 2016, consecutive ICU patients with virology-proven influenza infections who fulfilled ARDS and received invasive mechanical ventilation were enrolled. The impact of early corticosteroid treatment (? 200?mg hydrocortisone equivalent dose within 3?days after ICU admission, determined by a sensitivity analysis) on hospital mortality (the primary outcome) was assessed by multivariable logistic regression analysis, and further confirmed in a propensity score-matched cohort. Results: Among the 241 patients with influenza-associated ARDS, 85 (35.3%) patients receiving early corticosteroid treatment had similar baseline characteristics, but a significantly higher hospital mortality rate than those without early corticosteroid treatment [43.5% (37/85) vs. 19.2% (30/156), p < 0.001]. Early corticosteroid treatment was independently associated with increased hospital mortality in overall patients [adjusted odds ratio (95% CI) = 5.02 (2.39–10.54), p < 0.001] and in all subgroups. Earlier treatment and higher dosing were associated with higher hospital mortality. Early corticosteroid treatment was associated with a significantly increased odds of subsequent bacteremia [adjusted odds ratio (95% CI) = 2.37 (1.01–5.56)]. The analyses using a propensity score-matched cohort showed consistent results. Conclusions: Early corticosteroid treatment was associated with a significantly increased hospital mortality in adult patients with influenza-associated ARDS. Earlier treatment and higher dosing were associated with higher hospital mortality. Clinicians should be cautious while using corticosteroid treatment in this patient group. ? 2020, The Author(s).
SDGs
Other Subjects
albumin; hydrocortisone; hypertensive factor; adult; adult respiratory distress syndrome; aged; APACHE; arterial oxygen tension; Article; artificial ventilation; bacteremia; body mass; clinical outcome; cohort analysis; comparative study; controlled study; corticosteroid therapy; disease association; drug activity; early intervention; extracorporeal oxygenation; female; hemodialysis; hospital mortality; human; influenza; intensive care unit; leukocyte; major clinical study; male; malignant neoplasm; multicenter study; partial pressure; priority journal; retrospective study; reverse transcription polymerase chain reaction; risk factor; sensitivity analysis; Taiwan
Publisher
Springer
Type
journal article