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

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    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
    Show allShow less
    Affiliation
    Critical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona, Spain.
    Issue Date
    2011-02
    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
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    Metadata
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    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
    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
    ISSN
    1432-1238
    ae974a485f413a2113503eed53cd6c53
    10.1007/s00134-010-2078-z
    Scopus Count
    Collections
    Cork University Hospital

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