Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection.
Moreno, R P
Chiche, J D
Pearse, R M
AffiliationCritical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona, Spain.
MeSHAdrenal Cortex Hormones
Influenza A Virus, H1N1 Subtype
Intensive Care Units
Severity of Illness Index
MetadataShow full item record
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 Med
JournalIntensive care medicine
AbstractEarly 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.
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- Authors: Diaz E, Martin-Loeches I, Canadell L, Vidaur L, Suarez D, Socias L, Estella A, Gil Rueda B, Guerrero JE, Valverdú-Vidal M, Vergara JC, López-Pueyo MJ, Magret M, Recio T, López D, Rello J, Rodriguez A, H1N1 SEMICYUC-CIBERES-REIPI Working Group (GETGAG).
- Issue date: 2012 Mar
- First influenza season after the 2009 pandemic influenza: report of the first 300 ICU admissions in Spain.
- Authors: Rodríguez A, Martin-Loeches I, Bonastre J, Olaechea P, Alvarez-Lerma F, Zaragoza R, Guerrero J, Blanco J, Gordo F, Pozo F, Lorente J, Carratalá J, Cordero M, Rello J, Esteban A, León C, SEMICYUC-CIBERES-REIPI working group.
- Issue date: 2011 May
- Early corticosteroids in severe influenza A/H1N1 pneumonia and acute respiratory distress syndrome.
- Authors: Brun-Buisson C, Richard JC, Mercat A, Thiébaut AC, Brochard L, REVA-SRLF A/H1N1v 2009 Registry Group.
- Issue date: 2011 May 1
- Corticosteroid therapy in intensive care unit patients with PCR-confirmed influenza A(H1N1) infection in Finland.
- Authors: Linko R, Pettilä V, Ruokonen E, Varpula T, Karlsson S, Tenhunen J, Reinikainen M, Saarinen K, Perttilä J, Parviainen I, Ala-Kokko T, FINNH1N1-STUDY GROUP.
- Issue date: 2011 Sep
- Corticosteroid treatment in critically ill patients with pandemic influenza A/H1N1 2009 infection: analytic strategy using propensity scores.
- Authors: Kim SH, Hong SB, Yun SC, Choi WI, Ahn JJ, Lee YJ, Lee HB, Lim CM, Koh Y, Korean Society of Critical Care Medicine H1N1 Collaborative.
- Issue date: 2011 May 1