Association between systemic corticosteroids and outcomes of intensive care unit–acquired pneumonia
Critical Care Medicine, 08/21/2012
Ranzani OT et al. – 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.Methods
- Three hundred sixteen patients with intensive care unit–acquired pneumonia.
- Patients were divided according to previous systemic steroid use at onset of pneumonia.
- Survival at 28days 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.