Intensive Care Medicine

, Volume 37, Issue 2, pp 272–283

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

Authors

  • I. Martin-Loeches
    • Critical Care DepartmentJoan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes)
  • T. Lisboa
    • Critical Care DepartmentJoan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes)
    • Critical Care DepartmentHospital de Clinicas de Porto Alegre
  • A. Rhodes
    • Critical Care Department, St. George’s Healthcare NHS Trust
  • R. P. Moreno
    • Unidade de Cuidados Intensivos PolivalenteHospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E.
  • E. Silva
    • ICU, Hospital Israelita Albert Einstein
  • C. Sprung
    • Department of Anesthesiology and Critical Care MedicineHadassah Hebrew University Medical Center
  • J. D. Chiche
    • Service de Réanimation Médicale, Hôpital Cochin (AP-HP)Université Paris Descartes
  • D. Barahona
    • Unidad de Cuidados IntensivosHospital Eugenio Espejo
  • M. Villabon
    • Unidad de Cuidados IntensivosHospital de San José
  • C. Balasini
    • Unidad de Cuidados IntensivosHospital San Martín
  • R. M. Pearse
    • Barts and The London School of Medicine and DentistryQueen Mary’s University of London Royal London Hospital
  • R. Matos
    • Unidade de Cuidados Intensivos PolivalenteHospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E.
    • Critical Care Department, Vall d’Hebron University Hospital, Institut de Recerca Vall D’HebronUniversity Autonoma Barcelona, CIBER Enfermedades Respiratorias (CIBERes)
  • The ESICM H1N1 Registry Contributors
Original

DOI: 10.1007/s00134-010-2078-z

Cite this article as:
Martin-Loeches, I., Lisboa, T., Rhodes, A. et al. Intensive Care Med (2011) 37: 272. doi:10.1007/s00134-010-2078-z

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.

Keywords

Community acquired pneumoniaPandemic (H1N1)v influenza A infectionCorticosteroid therapyARDS

Copyright information

© Copyright jointly held by Springer and ESICM 2010