Corticosteroids influence the mortality and morbidity of acute critical illness.
BACKGROUND
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.


CONCLUSIONS
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.
Rady
Mohamed Y
MY
Department of Critical Care Medicine, Mayo Clinic College of Medicine, Mayo Clinic Hospital, Mayo Clinic, Phoenix, Arizona, USA. editorial@ccforum.com
Johnson
Daniel J
DJ
Patel
Bhavesh
B
Larson
Joel
J
Helmers
Richard
R
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D003141:Communicable Diseases / Q000453:epidemiology / Q000401:mortality; D015897:Comorbidity; D016638:Critical Illness / Q000453:epidemiology / Q000401:mortality*; D003428:Cross Infection / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors
D000305:Adrenal Cortex Hormones