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Intensive Care Medicine
Published in: Intensive Care Medicine 2/2011

01-02-2011 | Original

Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection

Authors: I. Martin-Loeches, T. Lisboa, A. Rhodes, R. P. Moreno, E. Silva, C. Sprung, J. D. Chiche, D. Barahona, M. Villabon, C. Balasini, R. M. Pearse, R. Matos, J. Rello, The ESICM H1N1 Registry Contributors

Published in: Intensive Care Medicine | Issue 2/2011

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Abstract

Introduction

Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial.

Methods

Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry.

Results

Two hundred twenty patients admitted to an intensive care unit (ICU) with completed outcome data were analyzed. Invasive mechanical ventilation was used in 155 (70.5%). Sixty-seven (30.5%) of the patients died in ICU and 75 (34.1%) whilst in hospital. One hundred twenty-six (57.3%) patients received corticosteroid therapy on admission to ICU. Patients who received corticosteroids were significantly older and were more likely to have coexisting asthma, chronic obstructive pulmonary disease (COPD), and chronic steroid use. These patients receiving corticosteroids had increased likelihood of developing hospital-acquired pneumonia (HAP) [26.2% versus 13.8%, p < 0.05; odds ratio (OR) 2.2, confidence interval (CI) 1.1–4.5]. Patients who received corticosteroids had significantly higher ICU mortality than patients who did not (46.0% versus 18.1%, p < 0.01; OR 3.8, CI 2.1–7.2). Cox regression analysis adjusted for severity and potential confounding factors identified that early use of corticosteroids was not significantly associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7–2.4, p = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0–4.8, p < 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed.

Conclusions

Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections.
Appendix
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Metadata
Title
Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection
Authors
I. Martin-Loeches
T. Lisboa
A. Rhodes
R. P. Moreno
E. Silva
C. Sprung
J. D. Chiche
D. Barahona
M. Villabon
C. Balasini
R. M. Pearse
R. Matos
J. Rello
The ESICM H1N1 Registry Contributors
Publication date
01-02-2011
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 2/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-010-2078-z

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