Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection.
Authors
Martin-Loeches, ILisboa, 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.Issue Date
2011-02MeSH
Adrenal Cortex HormonesAdult
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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Show full item recordCitation
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 MedPublisher
SpringerJournal
Intensive care medicineDOI
10.1007/s00134-010-2078-zPubMed ID
21107529Abstract
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
ArticleLanguage
enISSN
1432-1238ae974a485f413a2113503eed53cd6c53
10.1007/s00134-010-2078-z
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