Corticosteroid use in the intensive care unit: at what cost?
OBJECTIVE
Corticosteroid use has a significant effect on morbidity and mortality in the intensive care unit (ICU).


METHODS
Case-control study.


METHODS
Burn-trauma ICU in a level 1 trauma center.


METHODS
All patients who received corticosteroids while in the ICU from January 1, 2002, to December 31, 2003 (n = 100), matched by age and Injury Severity Score with a control group (n = 100).


METHODS
None.


METHODS
We considered the following 7 outcomes: pneumonia, bloodstream infection, urinary tract infection, other infections, ICU length of stay (LOS), ventilator LOS, and mortality.


RESULTS
Cases and controls had similar APACHE II (Acute Physiology and Chronic Health Evaluation II) scores and medical history. In univariate analysis, the corticosteroid group had a significant increase in pneumonia (26% vs 12%; P<.01), bloodstream infection (19% vs 7%; P<.01), and urinary tract infection (17% vs 8%; P<.05). In multivariate models, corticosteroid use was associated with an increased rate of pneumonia (odds ratio [OR], 2.64; 95% confidence interval [CI], 1.21-5.75) and bloodstream infection (OR, 3.25; 95% CI, 1.26-8.37). There was a trend toward increased urinary tract infection (OR, 2.31; 95% CI, 0.94-5.69), other infections (OR, 2.57; 95% CI, 0.87-7.67), and mortality (OR, 1.89; 95% CI, 0.81-4.40). Patients in the ICU who received corticosteroids had a longer ICU LOS by 7 days (P<.01) and longer ventilator LOS by 5 days (P<.01).


CONCLUSIONS
Corticosteroid use is associated with increased rate of infection, increased ICU and ventilator LOS, and a trend toward increased mortality. Caution must be taken to carefully consider the indications, risks, and benefits of corticosteroids when deciding on their use.
Britt
Rebecca C
RC
Department of Surgery, Eastern Virginia Medical School, Norfolk 23507, USA. brittrc@evms.edu
Devine
Alicia
A
Swallen
Karen C
KC
Weireter
Leonard J
LJ
Collins
Jay N
JN
Cole
Frederic J
FJ
Britt
L D
LD
D000328:Adult; D002053:Burn Units / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends*; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control*
D005938:Glucocorticoids