Détail du document
Identifiant
oai:pubmedcentral.nih.gov:7046...
Sujet
ResearchAuteur
Tsai, Ming-Ju Yang, Kuang-Yao Chan, Ming-Cheng Kao, Kuo-Chin Wang, Hao-Chien Perng, Wann-Cherng Wu, Chieh-Liang Liang, Shinn-Jye Fang, Wen-Feng Tsai, Jong-Rung Chang, Wei-An Chien, Ying-Chun Chen, Wei-Chih Hu, Han-Chung Lin, Chiung-Yu Chao, Wen-Cheng Sheu, Chau-ChyunLangue
enEditeur
Springer International Publishing
Catégorie
Annals of Intensive Care
Année
2020
Date de référencement
03/10/2023
Mots clés
significantly influenza odds increased impact mortality hospital associated ards treatmentRésumé
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.
Tsai, Ming-Ju,Yang, Kuang-Yao,Chan, Ming-Cheng,Kao, Kuo-Chin,Wang, Hao-Chien,Perng, Wann-Cherng,Wu, Chieh-Liang,Liang, Shinn-Jye,Fang, Wen-Feng,Tsai, Jong-Rung,Chang, Wei-An,Chien, Ying-Chun,Chen, Wei-Chih,Hu, Han-Chung,Lin, Chiung-Yu,Chao, Wen-Cheng,Sheu, Chau-Chyun,, 2020, Impact of corticosteroid treatment on clinical outcomes of influenza-associated ARDS: a nationwide multicenter study, Springer International Publishing
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