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Corticosteroids influence the mortality and morbidity of acute critical illness

INTRODUCTION: Use of corticosteroids for adrenal supplementation and attenuation of the inflammatory and immune response is widespread in acute critical illness. The study hypothesis was that exposure to corticosteroids influences the mortality and morbidity in acute critical illness. METHODS: This...

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Autores principales: Rady, Mohamed Y, Johnson, Daniel J, Patel, Bhavesh, Larson, Joel, Helmers, Richard
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2006
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1750970/
https://www.ncbi.nlm.nih.gov/pubmed/16846529
http://dx.doi.org/10.1186/cc4971
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author Rady, Mohamed Y
Johnson, Daniel J
Patel, Bhavesh
Larson, Joel
Helmers, Richard
author_facet Rady, Mohamed Y
Johnson, Daniel J
Patel, Bhavesh
Larson, Joel
Helmers, Richard
author_sort Rady, Mohamed Y
collection PubMed
description INTRODUCTION: Use of corticosteroids for adrenal supplementation and attenuation of the inflammatory and immune response is widespread in acute critical illness. The study hypothesis was that exposure to corticosteroids influences the mortality and morbidity in acute critical illness. METHODS: This case–control retrospective study was performed in a single multidisciplinary intensive care unit at a tertiary care institution and consisted of 10,285 critically ill patients admitted between 1 January 1999 and 31 December 2004. Demographics, comorbidities, acute illness characteristics including severity measured by Sequential Organ Failure Assessment, concurrent medications, therapeutic interventions and incidence of infections were obtained from electronic medical records, were examined with multiple regression analysis and were adjusted for propensity of corticosteroid exposure. The primary outcome was hospital death, and the secondary outcome was transfer to a care facility at hospital discharge. RESULTS: Corticosteroid exposure in 2,632 (26%) patients was characterized by younger age, more females, higher Charlson comorbidity and maximal daily Sequential Organ Failure Assessment scores compared with control patients. Corticosteroids potentiated metabolic and neuromuscular sequels of critical illness with increased requirements for diuretics, insulin, protracted weaning from mechanical ventilation, need for tracheostomy and discharge to a care facility. Early exposure to corticosteroids predisposed to recurrent and late onset of polymicrobial and fungal hospital-acquired infections. Corticosteroids increased the risk for death or disability after adjustments for comorbidities and acute illness characteristics. CONCLUSION: Corticosteroids increased the risk for death or disability in critical illness. Hospital-acquired infections and metabolic and neuromuscular sequels of critical illness were exacerbated by corticosteroids. Careful appraisal of the indications for use of corticosteroids is necessary to balance the benefits and risks from exposure in acute critical illness.
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spelling pubmed-17509702006-12-27 Corticosteroids influence the mortality and morbidity of acute critical illness Rady, Mohamed Y Johnson, Daniel J Patel, Bhavesh Larson, Joel Helmers, Richard Crit Care Research INTRODUCTION: Use of corticosteroids for adrenal supplementation and attenuation of the inflammatory and immune response is widespread in acute critical illness. The study hypothesis was that exposure to corticosteroids influences the mortality and morbidity in acute critical illness. METHODS: This case–control retrospective study was performed in a single multidisciplinary intensive care unit at a tertiary care institution and consisted of 10,285 critically ill patients admitted between 1 January 1999 and 31 December 2004. Demographics, comorbidities, acute illness characteristics including severity measured by Sequential Organ Failure Assessment, concurrent medications, therapeutic interventions and incidence of infections were obtained from electronic medical records, were examined with multiple regression analysis and were adjusted for propensity of corticosteroid exposure. The primary outcome was hospital death, and the secondary outcome was transfer to a care facility at hospital discharge. RESULTS: Corticosteroid exposure in 2,632 (26%) patients was characterized by younger age, more females, higher Charlson comorbidity and maximal daily Sequential Organ Failure Assessment scores compared with control patients. Corticosteroids potentiated metabolic and neuromuscular sequels of critical illness with increased requirements for diuretics, insulin, protracted weaning from mechanical ventilation, need for tracheostomy and discharge to a care facility. Early exposure to corticosteroids predisposed to recurrent and late onset of polymicrobial and fungal hospital-acquired infections. Corticosteroids increased the risk for death or disability after adjustments for comorbidities and acute illness characteristics. CONCLUSION: Corticosteroids increased the risk for death or disability in critical illness. Hospital-acquired infections and metabolic and neuromuscular sequels of critical illness were exacerbated by corticosteroids. Careful appraisal of the indications for use of corticosteroids is necessary to balance the benefits and risks from exposure in acute critical illness. BioMed Central 2006 2006-07-17 /pmc/articles/PMC1750970/ /pubmed/16846529 http://dx.doi.org/10.1186/cc4971 Text en Copyright © 2006 Rady et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Rady, Mohamed Y
Johnson, Daniel J
Patel, Bhavesh
Larson, Joel
Helmers, Richard
Corticosteroids influence the mortality and morbidity of acute critical illness
title Corticosteroids influence the mortality and morbidity of acute critical illness
title_full Corticosteroids influence the mortality and morbidity of acute critical illness
title_fullStr Corticosteroids influence the mortality and morbidity of acute critical illness
title_full_unstemmed Corticosteroids influence the mortality and morbidity of acute critical illness
title_short Corticosteroids influence the mortality and morbidity of acute critical illness
title_sort corticosteroids influence the mortality and morbidity of acute critical illness
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1750970/
https://www.ncbi.nlm.nih.gov/pubmed/16846529
http://dx.doi.org/10.1186/cc4971
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