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

Ignacio Martin-Loeches, Thiago Lisboa, Andrew Rhodes, R. P. Moreno, Eliezer Silva, C. Sprung, Jean Daniel Chiche, Diego Barahona, Mario Villabon, Carina Balasini, Rupert Pearse, Ricardo Matos, Jordi Rello, Alejandro Rodriguez, Maurizia Capuzzo, Rosa Reina, Brian Marsh, Haans Flaaten, Gisli Sigurdsson, Zykova IvanaVladimir Cerny, Michael Quintel, Tobias Welte, Manuel Mayorga, Georges Offenstadt, Bertrand Guidet, Phillip Levin, Hans Ulrich Rothen, Charles Gomersall, Seyed Mohammadreza Hashemian, Constantine Katsanoulas, Heleni Mouloudi, Farhad Kapadia, Andreas Valentin, Goran Hedenstierna, Anders Perner, Guillermo Bugedo, Esko Ruokonen, Antoni Soriano Arandes, Juan C. Montejo, Ramón Peñíscola, Cecilia Hermosa, Federico Gordo, Jaime Latour, Loreto Vidaur, Manuel Alvarez-Gonzalez, Luis Alvarez-Rocha, Ana De Pablo, Cristina Ferri, Lopez De Arbina Martinez, Cortés Cânones, Josu Insausti, Jose Cambronero, Beatriz Galvan, José Luna, Rafael Blancas, Carmen Garcia, Rafael Sierra, Francisco Fernández Dorado, Pablo Monedero, Jose Llagunes, Pedro Cobo, Antonia Socias, Rafael Leon-Lopez, Elisabeth Esteban, Marquina Lacueva, Monica Magret, Frutos Del Nogal, Alexandra Dinis, Anabela Bártolo, Armindo Ramos, Carlos Franca, Celso Estevens, Cristina Granja, Custódio Fidalgo, Eduardo Almeida, Estevão Lafuente, Fernando Rua, Francisco Esteves, José Clemente, José Júlio Nóbrega, José Manuel Pereira, José Pedro Moura, Luís Paulo Trindade E Silva, Luís Telo, Lurdes Santos, Maria José Pedrosa, Maria Oliveira, Margarida Resende, Nuno Catorze, Paula Coutinho, Rosa Ribeiro, Rui Moreno, Isabel Miranda, Teresa Cardoso, Vítor Branco, Giacomo Bellani, Ros Urbino, Adriano Peris, Alessandro Amatu, Giorgio Berlot, Federico Capra Marzani, Ulisse Corbanese, Antonio David, Paolo Chiarandini, Francesco Della Corte, Maria Luisa Caspani, Conio Alessandra, Valerio Mangani, Romano Tetamo, Andrea Wolfler, Giuseppe Tappatà, Vivaldi Nicoletta, Guido Bertolini, Lorella Pelagalli, Alexandre Molin, Massimo Girardis, Giuseppe Gristin, Ammy Lam, Ian Crabb, Rebecca Cusack, Rhiannon Jackson, Chithambaram Veerappan, Craig Whiteley, Tony Ware, Stephan Krueper, Caleb Mckinstry, Andrew Ferguson, Francesca Rubulotta, Erick Valencia, Susana Gonzalez, Victor Cevallos, Alan Zazu, Jeronimo Nahuel Chaparro Fresco, Gabriel Galindez, Cecilia Barrios, Carlos Lovesio, Boris Villamagua, Mario Cadena, Estuardo Salgado, Marià Fernanda García, Gustavo Paredes, Maria Donnelly, Donall O'Croinin, John Bates, Niall Kavanagh, Brian O'Brien, Rob Plant, Michael Scully, Rachel Farragher, Louise Oliveira, Sergio Mataloun, Vicente Souza Dantas, Luiz Simvoulidis, Péricles Duarte, Cintia Grion, Almir Germano, Jon Henrik Laake, Elin Helset, Dagny Klausen, Hans Flaatten, Kari Bruheim, Bjarki Kristinsson, Sigurdur E. Sigurdsson, Jan Hrubý, Radka Valkova, Robert Janda, Ivana Zykova, Andrea Kernchen, Frank Bloos, Simone Rosseau, Jens Krassler, Frank Fischer, Abel Arroyo-Sanchez, Alejandro Barrionuevo Poquet, Ivan Ramos Palomino, Fabiola Rafael, Juan Salasfoch, Gregory Dubar, Jean Marie Tonnelier, Saber Barbar, Murielle Dobrzynski, Alexandre Mignon, Daniel Jakobson, Moti Klein, Eran Segal, Yaron Barlavie, Moshe Hersch, Zule Sicardi Salomón, Hervé Zender, Hans U. Rothen, Kenny Chan, Tom Buckley, Uros Batranovic, Ilons Schaffer, Jelena Sretkovic, Despoina Koulenti, Eleni Mouloudi, Phyllis Maria Clouva-Molyvdas, Mohan Gurjar, Deepak Vijayan, Georg Hinterholzer, Alexander Kulier, Carin Verlaat, Dirk Ebel, Johan Persson, Sten Walther, Per Petersen, Walter Swinnen, Vincent Collin, Hanne Olsen, Patricio Gutierrez, Guillaume Thiery, Heikki Laine, Arvydas Rumba, Sundaresan Maiyalagan, Thinh Bui

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial. Methods: Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry. Results: 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. Conclusions: 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. 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. Conclusions: 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.

Original languageEnglish
Pages (from-to)272-283
Number of pages12
JournalIntensive Care Medicine
Volume37
Issue number2
DOIs
Publication statusPublished - Feb 2011

Keywords

  • ARDS
  • Community acquired pneumonia
  • Corticosteroid therapy
  • Pandemic (H1N1)v influenza A infection

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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