title: Preadmission Oral Corticosteroids Are Associated With Reduced Risk of Acute Respiratory Distress Syndrome in Critically Ill Adults With Sepsis.
abstract: OBJECTIVE
  To determine the association between preadmission oral corticosteroid receipt and the development of acute respiratory distress syndrome in critically ill patients with sepsis.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Medical, surgical, trauma, and cardiovascular ICUs of an academic medical center.
  
  
  METHODS
  A total of 1,080 critically ill patients with sepsis.
  
  
  METHODS
  None.
  
  
  RESULTS
  The unadjusted occurrence rate of acute respiratory distress syndrome within 96 hours of ICU admission was 35% among patients who had received oral corticosteroids compared with 42% among those who had not (p = 0.107). In a multivariable analysis controlling for prespecified confounders, preadmission oral corticosteroids were associated with a lower incidence of acute respiratory distress syndrome in the 96 hours after ICU admission (odds ratio, 0.53; 95% CI, 0.33-0.84; p = 0.008), a finding that persisted in multiple sensitivity analyses. The median daily dose of oral corticosteroids among the 165 patients receiving oral corticosteroids, in prednisone equivalents, was 10 mg (interquartile range, 5-30 mg). Higher doses of preadmission oral corticosteroids were associated with a lower incidence of acute respiratory distress syndrome (odds ratio for 30 mg of prednisone compared with 5 mg 0.53; 95% CI, 0.32-0.86). In multivariable analyses, preadmission oral corticosteroids were not associated with in-hospital mortality (odds ratio, 1.41; 95% CI, 0.87-2.28; p = 0.164), ICU length of stay (odds ratio, 0.90; 95% CI, 0.63-1.30; p = 0.585), or ventilator-free days (odds ratio, 1.06; 95% CI, 0.71-1.57; p = 0.783).
  
  
  CONCLUSIONS
  Among ICU patients with sepsis, preadmission oral corticosteroids were independently associated with a lower incidence of early acute respiratory distress syndrome.
authors.affiliation: 1Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN. 2Division of Cardiology, University of Colorado Medical Center, Denver, CO. 3Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN. 4Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN. 5Section of Pulmonary/Critical Care & Allergy/Immunology, Louisiana State University School of Medicine, New Orleans, LA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: McKown
authors.forename: Erin M
authors.initials: EM
authors.lastname: McGuinn
authors.forename: Lorraine B
authors.initials: LB
authors.lastname: Ware
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: David R
authors.initials: DR
authors.lastname: Janz
authors.forename: Todd W
authors.initials: TW
authors.lastname: Rice
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Semler
mesh_terms: D018806:APACHE; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000305:Adrenal Cortex Hormones