Association between systemic corticosteroids and outcomes of intensive care unit-acquired pneumonia.
OBJECTIVE
The use of corticosteroids is frequent in critically-ill patients. However, little information is available on their effects in patients with intensive care unit-acquired pneumonia. We assessed patients' characteristics, microbial etiology, inflammatory response, and outcomes of previous corticosteroid use in patients with intensive care unit-acquired pneumonia.


METHODS
Prospective observational study.


METHODS
Intensive care units of a university teaching hospital.


METHODS
Three hundred sixteen patients with intensive care unit-acquired pneumonia. Patients were divided according to previous systemic steroid use at onset of pneumonia.


METHODS
None.


RESULTS
Survival at 28 days was analyzed using Cox regression, with adjustment for the propensity for receiving steroid therapy. One hundred twenty-five (40%) patients were receiving steroids at onset of pneumonia. Despite similar baseline clinical severity, steroid treatment was associated with decreased 28-day survival (adjusted hazard ratio for propensity score and mortality predictors 2.503; 95% confidence interval 1.176-5.330; p = .017) and decreased systemic inflammatory response. In post hoc analyses, steroid treatment had an impact on survival in patients with nonventilator intensive care unit-acquired pneumonia, those with lower baseline severity and organ dysfunction, and those without etiologic diagnosis or bacteremia. The cumulative dosage of corticosteroids had no significant effect on the risk of death, but bacterial burden upon diagnosis was higher in patients receiving steroid therapy.


CONCLUSIONS
In critically-ill patients, systemic corticosteroids should be used very cautiously because this treatment is strongly associated with increased risk of death in patients with intensive care unit-acquired pneumonia, particularly in the absence of established indications and in patients with lower baseline severity. Decreased inflammatory response may result in delayed clinical suspicion of intensive care unit-acquired pneumonia and higher bacterial count.
Servei de Pneumologia, Institut del Torax, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
Otavio Tavares
OT
Ranzani
Miquel
M
Ferrer
Mariano
M
Esperatti
Valeria
V
Giunta
Gianluigi Li
GL
Bassi
Carlos Roberto Ribeiro
CR
Carvalho
Antoni
A
Torres
D018806:APACHE; D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D002423:Cause of Death; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends*; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones