Cargando…

Early Corticosteroid Therapy May Increase Ventilator-Associated Lower Respiratory Tract Infection in Critically Ill Patients with COVID-19: A Multicenter Retrospective Cohort Study

Background: The coronavirus disease 2019 (COVID-19) pandemic has put significant pressure on hospitals and in particular on intensive care units (ICU). Some patients develop acute hypoxemic respiratory failure with profound hypoxia, which likely requires invasive mechanical ventilation during prolon...

Descripción completa

Detalles Bibliográficos
Autores principales: Mesland, Jean-Baptiste, Carlier, Eric, François, Bruno, Serck, Nicolas, Gerard, Ludovic, Briat, Charlotte, Piagnerelli, Michael, Laterre, Pierre-François
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9146632/
https://www.ncbi.nlm.nih.gov/pubmed/35630429
http://dx.doi.org/10.3390/microorganisms10050984
_version_ 1784716610638970880
author Mesland, Jean-Baptiste
Carlier, Eric
François, Bruno
Serck, Nicolas
Gerard, Ludovic
Briat, Charlotte
Piagnerelli, Michael
Laterre, Pierre-François
author_facet Mesland, Jean-Baptiste
Carlier, Eric
François, Bruno
Serck, Nicolas
Gerard, Ludovic
Briat, Charlotte
Piagnerelli, Michael
Laterre, Pierre-François
author_sort Mesland, Jean-Baptiste
collection PubMed
description Background: The coronavirus disease 2019 (COVID-19) pandemic has put significant pressure on hospitals and in particular on intensive care units (ICU). Some patients develop acute hypoxemic respiratory failure with profound hypoxia, which likely requires invasive mechanical ventilation during prolonged periods. Corticosteroids have become a cornerstone therapy for patients with severe COVID-19, though only little data are available regarding their potential harms and benefits, especially concerning the risk of a ventilator-associated lower respiratory tract infection (VA-LRTI). Methods: This retrospective multicenter study included patients admitted in four ICUs from Belgium and France for severe COVID-19, who required invasive mechanical ventilation (MV). We compared clinical and demographic variables between patients that received corticosteroids or not, using univariate, multivariate, and Fine and Gray analyses to identify factors influencing VA-LRTI occurrence. Results: From March 2020 to January 2021, 341 patients required MV for acute respiratory failure related to COVID-19, 322 of whom were included in the analysis, with 60.6% of them receiving corticosteroids. The proportion of VA-LRTI was significantly higher in the early corticosteroid group (63.1% vs. 48.8%, p = 0.011). Multivariable Fine and Gray modeling considering death and extubation as competing events revealed that the factors independently associated with VA-LRTI occurrence were male gender (adjusted sHR:1.7, p = 0.0022) and corticosteroids (adjusted sHR: 1.44, p = 0.022). Conclusions: in our multicenter retrospective cohort of COVID-19 patients undergoing MV, early corticosteroid therapy was independently associated with VA-LRTI.
format Online
Article
Text
id pubmed-9146632
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-91466322022-05-29 Early Corticosteroid Therapy May Increase Ventilator-Associated Lower Respiratory Tract Infection in Critically Ill Patients with COVID-19: A Multicenter Retrospective Cohort Study Mesland, Jean-Baptiste Carlier, Eric François, Bruno Serck, Nicolas Gerard, Ludovic Briat, Charlotte Piagnerelli, Michael Laterre, Pierre-François Microorganisms Article Background: The coronavirus disease 2019 (COVID-19) pandemic has put significant pressure on hospitals and in particular on intensive care units (ICU). Some patients develop acute hypoxemic respiratory failure with profound hypoxia, which likely requires invasive mechanical ventilation during prolonged periods. Corticosteroids have become a cornerstone therapy for patients with severe COVID-19, though only little data are available regarding their potential harms and benefits, especially concerning the risk of a ventilator-associated lower respiratory tract infection (VA-LRTI). Methods: This retrospective multicenter study included patients admitted in four ICUs from Belgium and France for severe COVID-19, who required invasive mechanical ventilation (MV). We compared clinical and demographic variables between patients that received corticosteroids or not, using univariate, multivariate, and Fine and Gray analyses to identify factors influencing VA-LRTI occurrence. Results: From March 2020 to January 2021, 341 patients required MV for acute respiratory failure related to COVID-19, 322 of whom were included in the analysis, with 60.6% of them receiving corticosteroids. The proportion of VA-LRTI was significantly higher in the early corticosteroid group (63.1% vs. 48.8%, p = 0.011). Multivariable Fine and Gray modeling considering death and extubation as competing events revealed that the factors independently associated with VA-LRTI occurrence were male gender (adjusted sHR:1.7, p = 0.0022) and corticosteroids (adjusted sHR: 1.44, p = 0.022). Conclusions: in our multicenter retrospective cohort of COVID-19 patients undergoing MV, early corticosteroid therapy was independently associated with VA-LRTI. MDPI 2022-05-08 /pmc/articles/PMC9146632/ /pubmed/35630429 http://dx.doi.org/10.3390/microorganisms10050984 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Mesland, Jean-Baptiste
Carlier, Eric
François, Bruno
Serck, Nicolas
Gerard, Ludovic
Briat, Charlotte
Piagnerelli, Michael
Laterre, Pierre-François
Early Corticosteroid Therapy May Increase Ventilator-Associated Lower Respiratory Tract Infection in Critically Ill Patients with COVID-19: A Multicenter Retrospective Cohort Study
title Early Corticosteroid Therapy May Increase Ventilator-Associated Lower Respiratory Tract Infection in Critically Ill Patients with COVID-19: A Multicenter Retrospective Cohort Study
title_full Early Corticosteroid Therapy May Increase Ventilator-Associated Lower Respiratory Tract Infection in Critically Ill Patients with COVID-19: A Multicenter Retrospective Cohort Study
title_fullStr Early Corticosteroid Therapy May Increase Ventilator-Associated Lower Respiratory Tract Infection in Critically Ill Patients with COVID-19: A Multicenter Retrospective Cohort Study
title_full_unstemmed Early Corticosteroid Therapy May Increase Ventilator-Associated Lower Respiratory Tract Infection in Critically Ill Patients with COVID-19: A Multicenter Retrospective Cohort Study
title_short Early Corticosteroid Therapy May Increase Ventilator-Associated Lower Respiratory Tract Infection in Critically Ill Patients with COVID-19: A Multicenter Retrospective Cohort Study
title_sort early corticosteroid therapy may increase ventilator-associated lower respiratory tract infection in critically ill patients with covid-19: a multicenter retrospective cohort study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9146632/
https://www.ncbi.nlm.nih.gov/pubmed/35630429
http://dx.doi.org/10.3390/microorganisms10050984
work_keys_str_mv AT meslandjeanbaptiste earlycorticosteroidtherapymayincreaseventilatorassociatedlowerrespiratorytractinfectionincriticallyillpatientswithcovid19amulticenterretrospectivecohortstudy
AT carliereric earlycorticosteroidtherapymayincreaseventilatorassociatedlowerrespiratorytractinfectionincriticallyillpatientswithcovid19amulticenterretrospectivecohortstudy
AT francoisbruno earlycorticosteroidtherapymayincreaseventilatorassociatedlowerrespiratorytractinfectionincriticallyillpatientswithcovid19amulticenterretrospectivecohortstudy
AT sercknicolas earlycorticosteroidtherapymayincreaseventilatorassociatedlowerrespiratorytractinfectionincriticallyillpatientswithcovid19amulticenterretrospectivecohortstudy
AT gerardludovic earlycorticosteroidtherapymayincreaseventilatorassociatedlowerrespiratorytractinfectionincriticallyillpatientswithcovid19amulticenterretrospectivecohortstudy
AT briatcharlotte earlycorticosteroidtherapymayincreaseventilatorassociatedlowerrespiratorytractinfectionincriticallyillpatientswithcovid19amulticenterretrospectivecohortstudy
AT piagnerellimichael earlycorticosteroidtherapymayincreaseventilatorassociatedlowerrespiratorytractinfectionincriticallyillpatientswithcovid19amulticenterretrospectivecohortstudy
AT laterrepierrefrancois earlycorticosteroidtherapymayincreaseventilatorassociatedlowerrespiratorytractinfectionincriticallyillpatientswithcovid19amulticenterretrospectivecohortstudy
AT earlycorticosteroidtherapymayincreaseventilatorassociatedlowerrespiratorytractinfectionincriticallyillpatientswithcovid19amulticenterretrospectivecohortstudy