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Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection
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 Intensi...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer-Verlag
2010
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079858/ https://www.ncbi.nlm.nih.gov/pubmed/21107529 http://dx.doi.org/10.1007/s00134-010-2078-z |
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author | Martin-Loeches, I. Lisboa, 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. |
author_facet | Martin-Loeches, I. Lisboa, 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. |
author_sort | Martin-Loeches, I. |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7079858 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | Springer-Verlag |
record_format | MEDLINE/PubMed |
spelling | pubmed-70798582020-03-23 Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection Martin-Loeches, I. Lisboa, 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. Intensive Care Med Original 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. Springer-Verlag 2010-11-24 2011 /pmc/articles/PMC7079858/ /pubmed/21107529 http://dx.doi.org/10.1007/s00134-010-2078-z Text en © Copyright jointly held by Springer and ESICM 2010 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. |
spellingShingle | Original Martin-Loeches, I. Lisboa, 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. Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection |
title | Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection |
title_full | Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection |
title_fullStr | Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection |
title_full_unstemmed | Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection |
title_short | Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection |
title_sort | use of early corticosteroid therapy on icu admission in patients affected by severe pandemic (h1n1)v influenza a infection |
topic | Original |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079858/ https://www.ncbi.nlm.nih.gov/pubmed/21107529 http://dx.doi.org/10.1007/s00134-010-2078-z |
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