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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2017

Open Access 01-12-2017 | Research

Protective effect of early low-dose hydrocortisone on ventilator-associated pneumonia in the cancer patients: a propensity score analysis

Authors: David Lagier, Laura Platon, Jérome Lambert, Laurent Chow-Chine, Antoine Sannini, Magali Bisbal, Jean-Paul Brun, Karim Asehnoune, Marc Leone, Marion Faucher, Djamel Mokart

Published in: Annals of Intensive Care | Issue 1/2017

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Abstract

Background

Ventilator-associated pneumonia (VAP) is a care-related event that could be promoted by immune suppression caused by critical diseases, malignancies and cancer treatments. Low dose of hydrocortisone was proposed for modulation of immune response in the critically ill population.

Methods

In this monocentric observational study, all cancer patients mechanically ventilated for more than 48 h were included. Effect of low-dose hydrocortisone administered during the first 48 h of mechanical ventilation was evaluated applying inverse probability weighting analysis after propensity score assessment. VAP impact on 1-year mortality, ICU length of stay and mechanical ventilation duration was secondarily determined.

Results

Within this cohort, 190 cancer patients were followed. VAP was confirmed in 22.1% of cases in the early hydrocortisone group and confirmed in 42.6% of cases in the no or late hydrocortisone group. Early hydrocortisone exhibited a protective effect on the risk of VAP (OR 0.23; 95% CI 0.12–0.44; P < 0.0001). VAP was associated with 1-year mortality (HR 1.60; 95% CI 1.10–2.34; P = 0.017) and increased ICU length of stay (mean extra length of stay: 4.2 days; 95% CI 0.6–7.8).

Conclusions

Immune modulation with low-dose hydrocortisone administered in the first days of mechanical ventilation could protect from VAP occurrence in cancer patients.
Literature
1.
Mokart D, Pastores SM, Darmon M. Has survival increased in cancer patients admitted to the ICU? Yes. Intensive Care Med. 2014;40(10):1570–2.CrossRefPubMed
2.
Azoulay E, Pene F, Darmon M, Lengline E, Benoit D, Soares M, et al. Managing critically Ill hematology patients: time to think differently. Blood Rev. 2015;29(6):359–67.CrossRefPubMed
3.
van Vught LA, Klein Klouwenberg PM, Spitoni C, Scicluna BP, Wiewel MA, Horn J, et al. Incidence, risk factors, and attributable mortality of secondary infections in the intensive care unit after admission for sepsis. JAMA. 2016;315(14):1469–79.CrossRefPubMed
4.
Kaufmann I, Briegel J, Schliephake F, Hoelzl A, Chouker A, Hummel T, et al. Stress doses of hydrocortisone in septic shock: beneficial effects on opsonization-dependent neutrophil functions. Intensive Care Med. 2008;34(2):344–9.CrossRefPubMed
5.
Keh D, Boehnke T, Weber-Cartens S, Schulz C, Ahlers O, Bercker S, et al. Immunologic and hemodynamic effects of “low-dose” hydrocortisone in septic shock: a double-blind, randomized, placebo-controlled, crossover study. Am J Respir Crit Care Med. 2003;167(4):512–20.CrossRefPubMed
6.
Kanangat S, Meduri GU, Tolley EA, Patterson DR, Meduri CU, Pak C, et al. Effects of cytokines and endotoxin on the intracellular growth of bacteria. Infect Immun. 1999;67(6):2834–40.PubMedPubMedCentral
7.
Meduri GU, Kanangat S, Stefan J, Tolley E, Schaberg D. Cytokines IL-1beta, IL-6, and TNF-alpha enhance in vitro growth of bacteria. Am J Respir Crit Care Med. 1999;160(3):961–7.CrossRefPubMed
8.
Sprung CL, Annane D, Keh D, Moreno R, Singer M, Freivogel K, et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med. 2008;358(2):111–24.CrossRefPubMed
9.
Roquilly A, Mahe PJ, Seguin P, Guitton C, Floch H, Tellier AC, et al. Hydrocortisone therapy for patients with multiple trauma: the randomized controlled HYPOLYTE study. JAMA. 2011;305(12):1201–9.CrossRefPubMed
10.
Azoulay E, Mokart D, Pene F, Lambert J, Kouatchet A, Mayaux J, et al. Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium–a groupe de recherche respiratoire en reanimation onco-hematologique study. J Clin Oncol. 2013;31(22):2810–8.CrossRefPubMed
11.
Lemiale V, Mokart D, Resche-Rigon M, Pene F, Mayaux J, Faucher E, et al. Effect of noninvasive ventilation vs oxygen therapy on mortality among immunocompromised patients with acute respiratory failure: a randomized clinical trial. JAMA. 2015;314(16):1711–9.CrossRefPubMed
12.
American Thoracic S. Infectious diseases society of A. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388–416.CrossRef
13.
14.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–10.CrossRefPubMed
15.
16.
Klompas M, Platt R. Ventilator-associated pneumonia-the wrong quality measure for benchmarking. Ann Intern Med. 2007;147(11):803–5.CrossRefPubMed
17.
Nair GB, Niederman MS. Ventilator-associated pneumonia: present understanding and ongoing debates. Intensive Care Med. 2015;41(1):34–48.CrossRefPubMed
18.
Bekaert M, Timsit JF, Vansteelandt S, Depuydt P, Vesin A, Garrouste-Orgeas M, et al. Attributable mortality of ventilator-associated pneumonia: a reappraisal using causal analysis. Am J Respir Crit Care Med. 2011;184(10):1133–9.CrossRefPubMed
19.
Melsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C, Bauer TT, et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis. 2013;13(8):665–71.CrossRefPubMed
20.
Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005;33(10):2184–93.CrossRefPubMed
21.
Timsit JF, Zahar JR, Chevret S. Attributable mortality of ventilator-associated pneumonia. Curr Opin Crit Care. 2011;17(5):464–71.CrossRefPubMed
22.
Batra P, Mathur P, John NV, Nair SA, Aggarwal R, Soni KD, et al. Impact of multifaceted preventive measures on ventilator-associated pneumonia at a single surgical centre. Intensive Care Med. 2015;41(12):2231–2.CrossRefPubMed
23.
Pileggi C, Bianco A, Flotta D, Nobile CG, Pavia M. Prevention of ventilator-associated pneumonia, mortality and all intensive care unit acquired infections by topically applied antimicrobial or antiseptic agents: a meta-analysis of randomized controlled trials in intensive care units. Crit Care. 2011;15(3):R155.CrossRefPubMedPubMedCentral
24.
Magill SS, Klompas M, Balk R, Burns SM, Deutschman CS, Diekema D, et al. Developing a new, national approach to surveillance for ventilator-associated events. Crit Care Med. 2013;41(11):2467–75.CrossRefPubMed
25.
Bouadma L, Sonneville R, Garrouste-Orgeas M, Darmon M, Souweine B, Voiriot G, et al. Ventilator-associated events: prevalence, outcome, and relationship with ventilator-associated pneumonia. Crit Care Med. 2015;43(9):1798–806.CrossRefPubMed
26.
27.
Angus DC, Opal S. Immunosuppression and secondary infection in sepsis: part, not all, of the story. JAMA. 2016;315(14):1457–9.CrossRefPubMed
28.
Landelle C, Lepape A, Voirin N, Tognet E, Venet F, Bohe J, et al. Low monocyte human leukocyte antigen-DR is independently associated with nosocomial infections after septic shock. Intensive Care Med. 2010;36(11):1859–66.CrossRefPubMed
29.
Asehnoune K, Roquilly A, Abraham E. Innate immune dysfunction in trauma patients: from pathophysiology to treatment. Anesthesiology. 2012;117(2):411–6.CrossRefPubMed
30.
Grimaldi D, Louis S, Pene F, Sirgo G, Rousseau C, Claessens YE, et al. Profound and persistent decrease of circulating dendritic cells is associated with ICU-acquired infection in patients with septic shock. Intensive Care Med. 2011;37(9):1438–46.CrossRefPubMed
31.
Monneret G, Lepape A, Voirin N, Bohe J, Venet F, Debard AL, et al. Persisting low monocyte human leukocyte antigen-DR expression predicts mortality in septic shock. Intensive Care Med. 2006;32(8):1175–83.CrossRefPubMed
32.
Mokart D, Darmon M, Azoulay E. The alveolar macrophage and acute respiratory distress syndrome: A silent actor? Am J Respir Crit Care Med. 2014;189(4):499–500.CrossRefPubMed
33.
Mokart D, Kipnis E, Guerre-Berthelot P, Vey N, Capo C, Sannini A, et al. Monocyte deactivation in neutropenic acute respiratory distress syndrome patients treated with granulocyte colony-stimulating factor. Crit Care. 2008;12(1):R17.CrossRefPubMedPubMedCentral
34.
Mokart D, Guery BP, Bouabdallah R, Martin C, Blache JL, Arnoulet C, et al. Deactivation of alveolar macrophages in septic neutropenic ARDS. Chest. 2003;124(2):644–52.CrossRefPubMed
35.
Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288(7):862–71.CrossRefPubMed
36.
Kalil AC, Sun J. Low-dose steroids for septic shock and severe sepsis: the use of Bayesian statistics to resolve clinical trial controversies. Intensive Care Med. 2011;37(3):420–9.CrossRefPubMed
37.
Keh D, Trips E, Marx G, Wirtz SP, Abduljawwad E, Bercker S, et al. Effect of hydrocortisone on development of shock among patients with severe sepsis: the HYPRESS randomized clinical trial. JAMA. 2016;316(17):1775–85.CrossRefPubMed
38.
Nguile-Makao M, Zahar JR, Francais A, Tabah A, Garrouste-Orgeas M, Allaouchiche B, et al. Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models. Intensive Care Med. 2010;36(5):781–9.CrossRefPubMed
39.
Melsen WG, Rovers MM, Koeman M, Bonten MJ. Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies. Crit Care Med. 2011;39(12):2736–42.CrossRefPubMed
Metadata
Title
Protective effect of early low-dose hydrocortisone on ventilator-associated pneumonia in the cancer patients: a propensity score analysis
Authors
David Lagier
Laura Platon
Jérome Lambert
Laurent Chow-Chine
Antoine Sannini
Magali Bisbal
Jean-Paul Brun
Karim Asehnoune
Marc Leone
Marion Faucher
Djamel Mokart
Publication date
01-12-2017
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2017
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-017-0329-7

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