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

Gerard Moreno| Alejandro Rodríguez| Luis F. Reyes| Josep Gomez| Jordi Sole-Violan| Emili Díaz| María Bodí| Sandra Trefler| Juan Guardiola| Juan C. Yébenes| Alex Soriano| José Garnacho-Montero| Lorenzo Socias| María del Valle Ortíz| Eudald Correig| Judith Marín-Corral| Montserrat Vallverdú-Vidal| Marcos I. Restrepo| Antoni Torres| Ignacio Martín-Loeches
Original
Volume 44, Issue 9 / September , 2018

Pages 1470 - 1482

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

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