Impact of corticosteroid treatment on clinical outcomes of influenza-associated ARDS: a nationwide multicenter study

Abstract

Background: Corticosteroid treatment has been widely used in the treatment of septic shock, influenza, and ARDS, although some previous studies discourage its use in severe influenza patients. This multicenter retrospective cohort study conducted in the intensive care units (ICUs) of eight medical centers across Taiwan aims to determine the real-world status of corticosteroid treatment in patients with influenza-associated acute respiratory distress syndrome (ARDS) and its impact on clinical outcomes. Between October 2015 and March 2016, consecutive ICU patients with virology-proven influenza infections who fulfilled ARDS and received invasive mechanical ventilation were enrolled. The impact of early corticosteroid treatment (≥ 200 mg hydrocortisone equivalent dose within 3 days after ICU admission, determined by a sensitivity analysis) on hospital mortality (the primary outcome) was assessed by multivariable logistic regression analysis, and further confirmed in a propensity score-matched cohort. Results:Among the 241 patients with influenza-associated ARDS, 85 (35.3%) patients receiving early corticosteroid treatment had similar baseline characteristics, but a significantly higher hospital mortality rate than those without early corticosteroid treatment [43.5% (37/85) vs. 19.2% (30/156), p < 0.001]. Early corticosteroid treatment was independently associated with increased hospital mortality in overall patients [adjusted odds ratio (95% CI) = 5.02 (2.39-10.54), p < 0.001] and in all subgroups. Earlier treatment and higher dosing were associated with higher hospital mortality. Early corticosteroid treatment was associated with a significantly increased odds of subsequent bacteremia [adjusted odds ratio (95% CI) = 2.37 (1.01-5.56)]. The analyses using a propensity score-matched cohort showed consistent results. Conclusions:Early corticosteroid treatment was associated with a significantly increased hospital mortality in adult patients with influenza-associated ARDS. Earlier treatment and higher dosing were associated with higher hospital mortality. Clinicians should be cautious while using corticosteroid treatment in this patient group.

Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis

“…37 Our search for primary studies identified 1 new eligible study published in 2020. 38 Including 30 studies identified from the previous review, we identified 31 eligible studies, of which 21 with 9536 patients were included in meta-analyses. 41,[43][44][45][46][47]50,52,53,[55][56][57][58][59][60][61][63][64][65]68,69 Our search for systematic reviews for CAP identified 346 citations.…”

Corticosteroid treatment in severe COVID-19 patients with acute respiratory distress syndrome

“…Corticosteroids are potent immunomodulatory drugs that downregulate inflammation by nongenomic and genomic effects (7). Therefore, they have been broadly used in adults with ARDS with variable results (15,16). A metaanalysis from 4 trials suggested that in patients with SARS corticosteroids might have detrimental effects (10).…”

Corticosteroids for patients with acute respiratory distress syndrome: a systematic review and meta-analysis of randomized trials

“…24 The evidence on the use (benefits) of corti costeroids in patients with ARDS is highly am bivalent, complex, and based largely on obser vational nonrandomized studies. For example, a recently published multicenter retrospective cohort study by Tsai et al, 25 which included in tensive care units at medical centers across Tai wan, sought to assess the effectiveness of corti costeroids in patients presenting with influenza associated ARDS. The study revealed that, among the 241 patients included, those receiving cor ticosteroids early had a significantly higher in hospital mortality rate than those who did not (43.5% [37/85] vs 19.2% [30/156]; P <0.001).…”