Author, as appears in the article.: Moreno, Gerard; Rodriguez, Alejandro; Reyes, Luis F.; Gomez, Josep; Sole-Violan, Jordi; Diaz, Emili; Bodi, Maria; Trefler, Sandra; Guardiola, Juan; Yebenes, Juan C.; Soriano, Alex; Garnacho-Montero, Jose; Socias, Lorenzo; Ortiz, Maria del Valle; Correig, Eudald; Marin-Corral, Judith; Vallverdu-Vidal, Montserrat; Restrepo, Marcos I.; Torres, Antoni; Martin-Loeches, Ignacio;GETGAG Study Grp

Department: Medicina i Cirurgia

URV's Author/s: Bodi Saera, Maria Amparo / Cabre Vila, Juan Jose / Gómez Alvarez, Josep / Rodríguez Oviedo, Alejandro Hugo

Keywords: Pneumonia Mortality Influenza Icu Corticosteroids mortality influenza icu corticosteroids

Abstract: To determine clinical predictors associated with corticosteroid administration and its association with ICU mortality in critically ill patients with severe influenza pneumonia.Secondary analysis of a prospective cohort study of critically ill patients with confirmed influenza pneumonia admitted to 148 ICUs in Spain between June 2009 and April 2014. Patients who received corticosteroid treatment for causes other than viral pneumonia (e.g., refractory septic shock and asthma or chronic obstructive pulmonary disease [COPD] exacerbation) were excluded. Patients with corticosteroid therapy were compared with those without corticosteroid therapy. We use a propensity score (PS) matching analysis to reduce confounding factors. The primary outcome was ICU mortality. Cox proportional hazards and competing risks analysis was performed to assess the impact of corticosteroids on ICU mortality.A total of 1846 patients with primary influenza pneumonia were enrolled. Corticosteroids were administered in 604 (32.7%) patients, with methylprednisolone the most frequently used corticosteroid (578/604 [95.7%]). The median daily dose was equivalent to 80 mg of methylprednisolone (IQR 60-120) for a median duration of 7 days (IQR 5-10). Asthma, COPD, hematological disease, and the need for mechanical ventilation were independently associated with corticosteroid use. Crude ICU mortality was higher in patients who received corticosteroids (27.5%) than in patients who did not receive corticosteroids (18.8%, p < 0.001). After PS matching, corticosteroid use was associated with ICU mortality in the Cox (HR = 1.32 [95% CI 1.08-1.60], p < 0.006) and competing risks analysis (SHR = 1.37 [95% CI 1.12-1.68], p = 0.001).Administration of corticosteroids in patients with severe influenza pneumonia is associated with increased ICU mortality, and these agents should not be used as co-adjuvant therapy.

Thematic Areas: Saúde coletiva Odontología Nutrição Medicina iii Medicina ii Medicina i Interdisciplinar General medicine Farmacia Engenharias iv Enfermagem Emergency medicine & critical care Educação física Critical care medicine Critical care and intensive care medicine Ciências biológicas iii Ciências biológicas ii Ciências biológicas i

licence for use: https://creativecommons.org/licenses/by/3.0/es/

ISSN: 03424642

Author's mail: juanjose.cabre@urv.cat josep.gomez@urv.cat alejandrohugo.rodriguez@urv.cat mariaamparo.bodi@urv.cat mariaamparo.bodi@urv.cat

Author identifier: 0000-0003-1082-6861 0000-0002-0573-7621 0000-0001-8828-5984 0000-0001-7652-8379 0000-0001-7652-8379

Record's date: 2023-09-02

Papper version: info:eu-repo/semantics/acceptedVersion

Link to the original source: https://link.springer.com/article/10.1007%2Fs00134-018-5332-4

Licence document URL: http://repositori.urv.cat/ca/proteccio-de-dades/

Papper original source: Intensive Care Medicine. 44 (9): 1470-1482

APA: Moreno, Gerard; Rodriguez, Alejandro; Reyes, Luis F.; Gomez, Josep; Sole-Violan, Jordi; Diaz, Emili; Bodi, Maria; Trefler, Sandra; Guardiola, Juan; Ye (2018). Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study. Intensive Care Medicine, 44(9), 1470-1482. DOI: 10.1007/s00134-018-5332-4

Article's DOI: 10.1007/s00134-018-5332-4

Entity: Universitat Rovira i Virgili

Journal publication year: 2018

Publication Type: Journal Publications