Articles producció científica> Medicina i Cirurgia

Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study

  • Datos identificativos

    Identificador: imarina:3985206
    Autores:
    Moreno, GerardRodriguez, AlejandroReyes, Luis F.Gomez, JosepSole-Violan, JordiDiaz, EmiliBodi, MariaTrefler, SandraGuardiola, JuanYebenes, Juan C.Soriano, AlexGarnacho-Montero, JoseSocias, LorenzoOrtiz, Maria del ValleCorreig, EudaldMarin-Corral, JudithVallverdu-Vidal, MontserratRestrepo, Marcos I.Torres, AntoniMartin-Loeches, IgnacioGETGAG Study Grp
    Resumen:
    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 ass
  • Otros:

    Autor según el artículo: 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
    Departamento: Medicina i Cirurgia
    Autor/es de la URV: Bodi Saera, Maria Amparo / Cabre Vila, Juan Jose / Correig Fraga, Eudald / Gómez Alvarez, Josep / Rodríguez Oviedo, Alejandro Hugo / TREFLER CRESPO, SANDRA INES
    Palabras clave: Pneumonia Mortality Influenza Icu Corticosteroids mortality influenza icu corticosteroids
    Resumen: 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.
    Áreas temáticas: 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
    Acceso a la licencia de uso: https://creativecommons.org/licenses/by/3.0/es/
    ISSN: 03424642
    Direcció de correo del autor: eudald.correig@urv.cat juanjose.cabre@urv.cat josep.gomez@urv.cat alejandrohugo.rodriguez@urv.cat eudald.correig@urv.cat mariaamparo.bodi@urv.cat mariaamparo.bodi@urv.cat
    Identificador del autor: 0000-0003-1082-6861 0000-0002-0573-7621 0000-0001-8828-5984 0000-0001-7652-8379 0000-0001-7652-8379
    Fecha de alta del registro: 2024-09-07
    Versión del articulo depositado: info:eu-repo/semantics/acceptedVersion
    Enlace a la fuente original: https://link.springer.com/article/10.1007%2Fs00134-018-5332-4
    URL Documento de licencia: https://repositori.urv.cat/ca/proteccio-de-dades/
    Referencia al articulo segun fuente origial: Intensive Care Medicine. 44 (9): 1470-1482
    Referencia de l'ítem segons les normes 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
    DOI del artículo: 10.1007/s00134-018-5332-4
    Entidad: Universitat Rovira i Virgili
    Año de publicación de la revista: 2018
    Tipo de publicación: Journal Publications
  • Palabras clave:

    Critical Care and Intensive Care Medicine,Critical Care Medicine,Emergency Medicine & Critical Care
    Pneumonia
    Mortality
    Influenza
    Icu
    Corticosteroids
    mortality
    influenza
    icu
    corticosteroids
    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
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