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

Hdl Handle:
http://hdl.handle.net/10147/198830
Title:
Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection.
Authors:
Martin-Loeches, I; Lisboa, T; Rhodes, A; Moreno, R P; Silva, E; Sprung, C; Chiche, J D; Barahona, D; Villabon, M; Balasini, C; Pearse, R M; Matos, R; Rello, J
Affiliation:
Critical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona, Spain.
Citation:
Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection. 2011, 37 (2):272-83 Intensive Care Med
Publisher:
Springer
Journal:
Intensive care medicine
Issue Date:
Feb-2011
URI:
http://hdl.handle.net/10147/198830
DOI:
10.1007/s00134-010-2078-z
PubMed ID:
21107529
Abstract:
Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial.; Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry.; 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.; 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.
Item Type:
Article
Language:
en
Description:
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.
MeSH:
Adrenal Cortex Hormones; Adult; Cross Infection; Europe; Female; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Intensive Care Units; Likelihood Functions; Male; Middle Aged; Pandemics; Pneumonia; Prospective Studies; Registries; Severity of Illness Index; Survival Analysis
ISSN:
1432-1238

Full metadata record

DC FieldValue Language
dc.contributor.authorMartin-Loeches, Ien
dc.contributor.authorLisboa, Ten
dc.contributor.authorRhodes, Aen
dc.contributor.authorMoreno, R Pen
dc.contributor.authorSilva, Een
dc.contributor.authorSprung, Cen
dc.contributor.authorChiche, J Den
dc.contributor.authorBarahona, Den
dc.contributor.authorVillabon, Men
dc.contributor.authorBalasini, Cen
dc.contributor.authorPearse, R Men
dc.contributor.authorMatos, Ren
dc.contributor.authorRello, Jen
dc.date.accessioned2011-12-23T10:42:53Z-
dc.date.available2011-12-23T10:42:53Z-
dc.date.issued2011-02-
dc.identifier.citationUse of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection. 2011, 37 (2):272-83 Intensive Care Meden
dc.identifier.issn1432-1238-
dc.identifier.pmid21107529-
dc.identifier.doi10.1007/s00134-010-2078-z-
dc.identifier.urihttp://hdl.handle.net/10147/198830-
dc.descriptionINTRODUCTION: 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.en
dc.description.abstractEarly use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial.-
dc.description.abstractProspective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry.-
dc.description.abstractTwo 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.-
dc.description.abstractEarly 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.-
dc.language.isoenen
dc.publisherSpringeren
dc.subject.meshAdrenal Cortex Hormones-
dc.subject.meshAdult-
dc.subject.meshCross Infection-
dc.subject.meshEurope-
dc.subject.meshFemale-
dc.subject.meshHumans-
dc.subject.meshInfluenza A Virus, H1N1 Subtype-
dc.subject.meshInfluenza, Human-
dc.subject.meshIntensive Care Units-
dc.subject.meshLikelihood Functions-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshPandemics-
dc.subject.meshPneumonia-
dc.subject.meshProspective Studies-
dc.subject.meshRegistries-
dc.subject.meshSeverity of Illness Index-
dc.subject.meshSurvival Analysis-
dc.titleUse of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection.en
dc.typeArticleen
dc.contributor.departmentCritical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona, Spain.en
dc.identifier.journalIntensive care medicineen
dc.description.provinceMunster-

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