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Intensive Care Medicine

, Volume 44, Issue 9, pp 1470–1482 | Cite as

Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study

  • Gerard Moreno
  • Alejandro RodríguezEmail author
  • Luis F. Reyes
  • Josep Gomez
  • Jordi Sole-Violan
  • Emili Díaz
  • María Bodí
  • Sandra Trefler
  • Juan Guardiola
  • Juan C. Yébenes
  • Alex Soriano
  • José Garnacho-Montero
  • Lorenzo Socias
  • María del Valle Ortíz
  • Eudald Correig
  • Judith Marín-Corral
  • Montserrat Vallverdú-Vidal
  • Marcos I. Restrepo
  • Antoni Torres
  • Ignacio Martín-Loeches
  • on behalf of the GETGAG Study Group
Original

Abstract

Purpose

To determine clinical predictors associated with corticosteroid administration and its association with ICU mortality in critically ill patients with severe influenza pneumonia.

Methods

Secondary analysis of a prospective cohort study of critically ill patients with confirmed influenza pneumonia admitted to 148 ICUs in Spain between June 2009 and April 2014. Patients who received corticosteroid treatment for causes other than viral pneumonia (e.g., refractory septic shock and asthma or chronic obstructive pulmonary disease [COPD] exacerbation) were excluded. Patients with corticosteroid therapy were compared with those without corticosteroid therapy. We use a propensity score (PS) matching analysis to reduce confounding factors. The primary outcome was ICU mortality. Cox proportional hazards and competing risks analysis was performed to assess the impact of corticosteroids on ICU mortality.

Results

A total of 1846 patients with primary influenza pneumonia were enrolled. Corticosteroids were administered in 604 (32.7%) patients, with methylprednisolone the most frequently used corticosteroid (578/604 [95.7%]). The median daily dose was equivalent to 80 mg of methylprednisolone (IQR 60–120) for a median duration of 7 days (IQR 5–10). Asthma, COPD, hematological disease, and the need for mechanical ventilation were independently associated with corticosteroid use. Crude ICU mortality was higher in patients who received corticosteroids (27.5%) than in patients who did not receive corticosteroids (18.8%, p < 0.001). After PS matching, corticosteroid use was associated with ICU mortality in the Cox (HR = 1.32 [95% CI 1.08–1.60], p < 0.006) and competing risks analysis (SHR = 1.37 [95% CI 1.12–1.68], p = 0.001).

Conclusion

Administration of corticosteroids in patients with severe influenza pneumonia is associated with increased ICU mortality, and these agents should not be used as co-adjuvant therapy.

Keywords

Influenza Pneumonia Corticosteroids ICU Mortality 

Notes

Acknowledgements

The authors are grateful to Michael Maudsley for language editing and Eudald Correig for the statistical analysis.

GETGAG (Grupo Español de Trabajo Gripe A Grave) Study Group Investigators. Andalucía: Pedro Cobo (Hospital Punta de Europa, Algeciras); Javier Martins (Hospital Santa Ana Motril, Granada); Cecilia Carbayo (Hospital Torrecardenas, Almería); Emilio Robles-Musso, Antonio Cárdenas, Javier Fierro (Hospital del Poniente, Almería); Dolores Ocaña Fernández (Hospital Huercal—Overa, Almería); Rafael Sierra (Hospital Puerta del Mar, Cádiz); Mª Jesús Huertos, Mª Luz Carmona Pérez (Hospital Puerto Real, Cádiz); Juan Carlos Pozo Laderas, R. Guerrero, Juan Carlos Robles, Melissa Echevarría León, Alberto Bermejo Gómez (Hospital Reina Sofía, Córdoba); Enrique Márquez (Hospital Infanta Elena, Huelva); Manuel Rodríguez-Carvajal (Hospital Juan Ramón Jiménez, Huelva); Ángel Estella (Hospital del SAS de Jerez, Jerez de la Frontera); José Pomares, José Luis Ballesteros, Olga Moreno Romero (Hospital Universitario San Cecilio, Granada); Yolanda Fernández, Francisco Lobato, José F. Prieto, José Albofedo-Sánchez (Hospital Costa del Sol, Marbella); Pilar Martínez; María Victoria de la Torre; María Nieto, Estefanía Camara Sola (Hospital Vírgen de la Victoria, Málaga); Miguel Angel Díaz Castellanos, (Hospital Santa Ana de Motril, Granada); Guillermo Sevilla Soler, Carlos Ortiz Leyba (Clínica Sagrado Corazón, Sevilla); José Garnacho-Montero, Rafael Hinojosa, Esteban Fernández, (Hospital Virgen del Rocío, Sevilla); Ana Loza, Cristóbal León, Samuel González López (Hospital Universitario Nuestra Señora de Valme, Sevilla); Angel Arenzana, (Hospital Virgen de la Macarena, Sevilla), Dolores Ocaña (Hospital de la Inmaculada, Sevilla), Inés Navarrete (Hospital Virgen de las Nieves, Granada), Medhi Zaheri Beryanaki (Hospital de Antequera); Ignacio Sánchez, Manuel Pérez Alé (Hospital NISA Sevilla ALJARAFE, Sevilla); Ana Mª Poullet Brea (Hospital Quirón Málaga, Málaga); Juan Francisco Machado Casas (Complejo Hospitalario de Jaén, Jaén). Aragón: Carlos Serón, Manuel Luis Avellanas, Arantxa Lander, S Garrido Ramírez de Arellano, MI Marquina Lacueva (Hospital San Jorge, Huesca); Pilar Luque; Elena Plumed Serrano; Juan Francisco Martín Lázaro, Carlos Sánchez Polo, Isabel Gutiérrez Cia, Belén Jiménez Bartolomé, Carlos López Nuñez (Hospital Lozano Blesa, Zaragoza); Ignacio González, José Ignacio Tomás Marsilla, Clara Jaques Andrés, Pablo Gutiérrez Ibañes, Pilar Araujo Aguilar (Hospital Miquel Servet, Zaragoza); Jose Mª Montón (Hospital Obispo Polanco, Teruel); Paloma Dorado Regil (Hospital Royo Villanova, Zaragoza). Asturias: Lisardo Iglesias, Carmen Pascual González, Brígida Quindós Fernández, Lorena Martín Iglesias, Lucía Viña Soria, Raquel Yano Escudero, Mª del Rosario Mtnez Revuelta (Hospital Universitario Central de Asturias—HUCA-UCI 1, Oviedo); Quiroga (Hospital De Cabueñes, Gijón); Águeda García-Rodríguez (Hospital Valle del Nalón, Langreo); Marta Martín Cuadrado, Ana Luz Balán Mariño (Hospital San Agustín, Avilés). Baleares: Lorenzo Socias, Pedro Ibánez, Marcío Borges-Sa; A. Socias, Del Castillo A (Hospital Son LLatzer, Palma de Mallorca); Ricard Jordà Marcos, Cristina Muñoz (Clínica Rotger, Palma de Mallorca); José M Bonell (USP. Clínica Palmaplanas, Palma de Mallorca); Ignacio Amestarán (Hospital Son Dureta, Palma de Mallorca); M. Angeles González López, Cecilia Vilanova Pàmies (Hospital Mateu Orfila, Palma de Mallorca); José Ma. Bonell Goytisolo, José Antonio Morales Carbonero (Hospital General de Muro, Palma de Mallorca); José Ma. Bonell Goytisolo, José Antonio Morales Carbonero (Clínica Quirón Palmaplanas, Palma de Mallorca), Rossana Pérez Senoff, Marta Generelo López de Medrano (Hospital Comarcal de Inca, Palma de Mallorca). Canarias: ergio Ruiz-Santana, Juan José Díaz, Catalina Sánchez Ramírez (Hospital Dr Negrín, Las Palmas de Gran Canaria); Montse Sisón (Hospital Doctor José Molina, Lanzarote); David Hernández, Ana Trujillo, Luis Regalado, Sonia Rodríguez Fndez (Hospital General la Palma, La Palma); Leonardo Lorente, Judith Cabrera Rivero, Mª Luisa Mora Quintero (Hospital Universitario de Canarias, Tenerife); Mar Martín (Hospital de la Candelaria, Tenerife), Sergio Martínez, J. J. Cáceres, Manuel Sanchez Palacio, Marcos (Hospital Insular de Gran Canaria); D. García Rodríguez, María Ripoll Leria (Hospital General de Fuerteventura, Fuerteventura). Cantabria: Borja Suberviola, P. Ugarte (Hospital Universitario Marqués de Valdecilla, Santander). Castilla La Mancha: Ernando García-López, Rafael Sánchez Iniesta (Hospital General, Albacete); Angel Álvaro Alonso, Antonio Padilla, Basi Martínez Palacios (Hospital General La Mancha Centro, Alcázar de San Juan); Mª Luisa Gómez Grande, Ma. Carmen Martín Rodríguez, Hasania Adbel-Hadi Álvarez, Alfonso Ambros Checa, Higinio Martín Hernández (Hospital General de Ciudad Real, Ciudad Real); Antonio Albaya, Alberto Silva Obregón, Carlos Marian Crespo, Carlos Armendariz Estrella, Carmen Benito Puncel, Eduardo Quirós Oyargue (Hospital Universitario de Guadalajara, Guadalajara); Alfonso Canabal, Luis Marina, Ismael López de Toro (Hospital Virgen de la Salud, Toledo); Almudena Simón (Hospital Nuestra Señora del Prado, Toledo); José María Añón (Hospital Virgen de la Luz, Cuenca). Castilla y León: Juan B López Messa, (Complejo Asistencial de Palencia, Palencia), Mª Jesús López Pueyo, Ortíz María del valle, Sergio Ossa Echeverri (Hospital General Yagüe, Burgos); Zulema Ferreras, Juan C Ballesteros Herraez (Hospital Universitario de Salamanca, Salamanca); Santiago Macias, (Hospital General de Segovia, Segovia); José Ángel Berezo, Jesús Blanco Varela, Pablo Blanco Schweizer, Angela González Salamanca, Luis Tamayo Lomas (Hospital Universitario Río Hortega, Valladolid), Andaluz Ojeda Anzález, Ramón Cicuéndez Avila, Francisco Javier Pérez G (Hospital Universitario, Valladolid); Antonio Álvarez Terrero (Hospital Virgen de la Concha, Zamora), Fabiola Tena Ezpeleta, Christian Sala, Oliverio López (Hospital Santa Bárbara, Soria); Zulema Paez; Álvaro García (Hospital Virgen Vega, Salamanca), Demetrio Carriedo Ule, Miriam Riesco Crespo (Complejo Asistencial Universitario de León-CAULE, León); Jesús Pino Rebolledo, Nicolás Hidalgo Andrés (Hospital Campo Grande, Valladolid); Ana Carolina Caballero Zirena (Complejo Asistencial de Zamora, Zamora); Belén Román García, Juan Bautista López Messa (Hospital General Río Carrión, Palencia); María del Valle Ortiz, Sergio Ossa Echeverri (Hospital Universitario de Burgos-HUBU, Burgos). Cataluña: Rosa Mª Catalán (Hospital General de Vic, Vic); Miquel Ferrer, Antoni Torres, Catia Cilloniz (Hospital Clínic, Barcelona); Sandra Barbadillo Ansorregui (Hospital General de Catalunya—CAPIO, Barcelona); Lluís Cabré, Ignacio Baeza (Hospital de Barcelona, Barcelona); Assumpta Rovira (Hospital General de l’Hospitalet, L’Hospitalet); Francisco Álvarez-Lerma, Antonia Vázquez, Joan Nolla ( Hospital Del Mar, Barcelona); Francisco Fernández, Joaquim Ramón Cervelló; Raquel Iglesia (Centro Médico Delfos, Barcelona); Rafael Mañéz, J. Ballús, Rosa Mª Granada (Hospital de Bellvitge, Barcelona); Jordi Vallés, Emili Díaz, Marta Ortíz, C. Guía, Ignacio Martín-Loeches ( Hospital de Sabadell, Sabadell); Joaquim Páez (Hospital Dos De Mayo, Barcelona); Jordi Almirall, Xavier Balanzo, Estel Güell, Juan Carlos Yebenes (Hospital de Mataró, Mataró); Elena Arnau, Marcos Pérez; César Laborda; Jesica Souto, Leonel Lagunes (Hospital Vall d’Hebron, Barcelona); Iñaki Catalán (Hospital Sant Joan de Déu, Manresa); Josep Mª Sirvent, Nerea López de Arbina, Anna Baró Serra, Adriana Sánchez, Silvia M. Cuenca (Hospital Josep Trueta, Girona); Mariona Badía, Begonia Baseda-Garrido, Montserrat Valverdú-Vidal, Fernando Barcenilla, Mercedes Palomar, Xavier Nuvials (Hospital Arnau de Vilanova, Lleida); Pedro Garrido Benedicto (Hospital Sant Joan de Reus, Reus); Ferran Roche-Campo, MF Esteban, José Luna, Gaspar Masdeu Eixarch, Angels Pascual Diago (Hospital Verge de la Cinta, Tortosa); Juan Mª Nava, J González de Molina, Josep Trenado, Ricard Ferrer (Hospital Universitario Mutua de Terrassa, Terrassa); Zoran Josic, Montserrat Casanovas (Hospital de Igualada, Igualada); Francisco Gurri; Paula Rodríguez (Hospital Quirón, Barcelona) Alejandro Rodríguez, Laura Claverias, Sandra Trefler, María Bodí, Mónica Magret, Cristina Ferri (Hospital Universitario Joan XXIII, Tarragona); Rosa María Díaz (Hospital San Camil. Sant Pere de Ribes, Barcelona); Eduard Mesalles, Fernando Arméstar (Hospital Germans Trias i Pujol, Badalona); Diego de Mendoza, Carmen Lomas Fernández, José Julián Berrade (Hospital M. Broggi, Sant Joan Despí); Alfonso Bonet Saris, Marina Pechkova (Clínica Girona, Girona); Cristina Mora Jiménez (Hospital Sagrat Cor, Barcelona); Santiago Picos Gil (Clínica Diagonal). Extremadura: Juliá-Narváez José, Manuel Robles Marcos, Vanessa Farje Mallqui, Mª. Angeles Santiago Triviño, Pablo Martínez García (Hospital Infanta Cristina, Badajoz), Alberto Fernández-Zapata, Teresa Recio, Abilio Arrascaeta, Mª José García-Ramos, Elena Gallego, Esther Saiz Rodrigo (Hospital San Pedro de Alcántara, Cáceres); Fernándo Bueno (Hospital Virgen del Puerto, Plasencia); Mercedes Díaz, Noemí Gil Pérez, David López Hormigo (Hospital de Mérida, Mérida); Juan Diego Jiménez Delgado (Hospital Don Benito, Villanueva de la Serena, Badajoz); Pérez frutos, Rivera Pinna MJ (Hospital Perpetuo Socorro). Galicia: Mª Lourdes Cordero, José A. Pastor, Luis Álvarez-Rocha, Alexandra Ceniceros Barros, Alejandra Virgós Pedreira (CHUAC, A Coruña); Dolores Vila, (Hospital Do Meixoeiro, Vigo); Carmen Fernández González (C.H.U. de Ferrol, Ferrol); Javier Blanco Pérez, M Ortiz Piquer, (Hospital Xeral—Calde, Lugo); Eleuterio Merayo, Victor Jose López-Ciudad, Juan Cortes Cañones, Eva Vilaboy, José Villar Chao, Francisco Savira Cid López, Pablo Vidal Cortés, Marcos A. Pérez Veloso(Complejo Hospitalario de Ourense, Ourense); Eva Maria Saborido, Enrique Alemparte Pardavila, Ana Ortega Montes (Hospital Montecelo, Pontevedra); Raul José González, (H. Miguel Domínguez, Pontevedra); Santiago Freita, Enrique Alemparte; Ana Ortega (Complejo Hospitalario de Pontevedra, Pontevedra); Ana María López; Julio Canabal, Enrique Ferres (Clinica Universitaria Santiago de Compostela, Santiago); Javier Blanco Pérez, M Ortiz Piquer (Hospital Lucus Augusti-HULA, Lugo); Santiago Freitas Ramos, Lucas Lage Cendón, Vanesa Gómez Casal, Sabela Vara Adrio, Eva Menor Fernández, Susana González Prado (H. Xeral—C.H.U. de Vigo, Vigo); Antonio Varela Franco (Hospital Vithas Nª Sª de Fátima, Vigo). La Rioja: José Luis Monzón, Félix Goñi (Hospital San Pedro, Logroño). Madrid: Frutos Del Nogal Sáez, M Blasco Navalpotro, Ricardo Díaz Abad, José Luis Flordelis Lasierra (Hospital Severo Ochoa, Madrid); Mª Carmen García-Torrejón (Hospital Infanta Elena, Madrid); César Pérez-Calvo, Diego López ( Fundación Jiménez Díaz, Madrid); Luis Arnaiz, S. Sánchez- Alonso, Carlos Velayos, (Hospital Fuenlabrada, Madrid); Francisco del Río, Miguel Ángel González, Mercedes Nieto, Carmen Sánchez Cesteros (Hospital Clínico San Carlos, Madrid); María Cruz Martín, José Mª Molina (Hospital Nuestra Señora de América, Madrid); Juan Carlos Montejo, Mercedes Catalán (Hospital Universitario 12 de Octubre, Madrid); Patricia Albert, Ana de Pablo (Hospital del Sureste, Arganda del rey); José Eugenio Guerrero, María Zurita; Jaime Benitez Peyrat, Miriam Díaz Cámara (Hospital Gregorio Marañón, Madrid); Enrique Cerdá, Manuel Alvarez, Carlos Pey, Eva Manteiga Riestra, Concepción Martinez-Fidalgo (Hospital Infanta Cristina, Parla); Montse Rodríguez, Eduardo Palencia (Hospital Infanta Leonor, Madrid); Rafael Caballero, (Hospital de San Rafael, Madrid); Concepción Vaquero, Francisco Mariscal, S. García, Rico Cepeda (Hospital Infanta Sofía, Madrid); Nieves Carrasco, (Hospital Universitario La Princesa, Madrid); Isidro Prieto, A Liétor, R. Ramos, Rosario Cuadra Casas, Cruz Soriano Cuesta, Susana Sánchez Alonso (Hospital Ramón y Cajal, Madrid); Beatriz Galván, Juan C. Figueira, M. Cruz Soriano, Bélen Civantos Martín, Alejgandro Robles Caballero (Hospital La Paz, Madrid); P Galdós, Bárbara Balandin Moreno, Sara Alcántara Carmona (Hospital Puerta de Hierro, Madrid); Fernández del Cabo (Hospital Monte Príncipe, Madrid); Cecilia Hermosa, Federico Gordo (Hospital de Henares, Madrid); Alejandro Algora (Hospital Universitario Fundación Alcorcón, Madrid); Amparo Paredes, Teodoro Grau Carmona (Hospital Sur de Alcorcón, Madrid); JA Cambroner, Esther López Ramos, Yaiza Ortiz de Zárate (Hospital Universitario Príncipe de Asturias, Madrid); Sonia Gómez-Rosado, Margarita Mas Lodo, Nieves Franco Garrobo, Silvia Álvarez Hernández, Teresa Honrubia (Hospital de Móstoles, Madrid); Luis Miguel Prado López (Hospital Sanitas La Zarzuela, Madrid); Esteban A, Lorente JA, Nin N, Carlos Jaramillo Sotomayor (Hospital de Getafe, Madrid); Luis Arnaiz (Sanitas de Moraleja, Madrid); Esperanza Molero Silvero, Eduardo Morales Fdez. de la Reguera (Hospital Central de la Defensa “Gómez Ulla”, Madrid); Rosa Mª de la Casa Monje, Fátima Martín Serrano (Clínica Moncloa, Madrid); Mª Victoria Trasmonte Martínez, M. Cruz Martín Delgado (Hospital de Torrejón, Torrejón de Ardoz). Murcia: Sofía Martínez (Hospital Santa María del Rosell, Murcia); F. Felices Abad, Isabel Cremades Navalon, Martín Vigil Velis (Hospital Universitario Reina Sofía, Murcia); Mariano Martínez, Domingo Martínez Baño, Enriqueta Andreu (Hospital Universitario Virgen de la Arrixaca, Murcia); Sergio Manuel Butí, Bernardo Gil Rueda, Francisco García ( Hospital Morales Messeguer, Murcia); Noemí Llamas Fernández (Hospital General Universitario Rafael Méndez, Lorca); Luis Herrera Para, Alejandro Ortín Freire (Hospital Universitario Santa Lucía, Cartagena); Mª Rosa Nvarro Ruiz, C.R. Hernández Romero (Hospital Los Arcos del Mar Menor, Murcia). Navarra: Enrique Maraví-Poma, I Jimenez Urra, Laura Macaya Redin, A Tellería (Hospital Virgen del Camino, Pamplona); Josu Insansti, (Hospital de Navarra, Pamplona). Noelia Artesero Garcia, Laura Macaya (Complejo Hospitalario Navarra-UCI A); Joaquín Lobo Palanco (Complejo Hospitalario Navarra UCI B). País Vasco: Nagore González, Pilar Marco, Loreto Vidaur, Estibaliz Salas, Ruth Salaberría Udabe (Hospital de Donostia, San Sebastián); B. Santamaría, Tomás Rodríguez (Hospital de Basurto, Bilbao); Juan Carlos Vergara, Jose Ramon Iruretagoyena Amiano, Iratí Garrido Santos (Hospital de Cruces, Bilbao); Alberto Manzano, (Hospital Santiago Apóstol, Vitoria); Carlos Castillo Arenal (Hospital Txagorritxu, Vitoria); Pedro María Olaechea, Higinio Martín Hernández (Hospital Galdakao-Usansolo, Vizcaya); Alejandro Martín López, Fernando Fonseca San Miguel (Hospital Universitario de Alava-Santiago, Vitoria). Valencia: José Blanquer, Nieves Carbonell, José Ferreres Franco (Hospital Clinic Universitari, Valencia); Roberto Reig Valero, A. Belenger, Susana Altaba (Hospital General de Castellón, Castellón); Bernabé Álvarez-Sánchez, José Canovas Robles, Jaime Sánchez Francisco, Mar Ruiz Sánchez (Hospital General de Alicante, Alicante); Santiago Alberto Picos, Abilio Arrascaeta Llanes, Eugenio Herrero Gutiérrez, Alberto Fernández Zapata (Hospital Torrevieja Salud, Alicante); Ángel Sánchez-Miralles, José Luis Antón Pascual (Hospital San Juan, Alicante); Juan Bonastre, M. Palamo, Javier Cebrian, José Cuñat, Mónica Gordón Sahuquillo (Hospital La Fe, Valencia); Belén Romero, Santiago Borrás Pallé, Javier de León Belmar (Hospital de Manises, Valencia); Rafael Zaragoza, Constantino Tormo, Susana Sancho Chinesta (Hospital Dr Peset, Valencia); Virgilio Paricio, (Hospital de Requena, Valencia); Asunción Marques, S. Sánchez-Morcillo, S. Tormo (Hospital de la Ribera, Valencia). J. Latour (H.G Universitario de Elche, Valencia), M Ángel García, Manuel Palomo (Hospital de Sagunto, Castellón), Francisco Tarín Royo, Pedro Manzano Hinojosa (Hospital de Denia, Alicante); Mª Salomé Sánchez Pino (Hospital Vega Baja, Alicante); Concha Maragues Ribes, Rubén González Luis (Hospital de la Plana, Castellón). Andorra: Antoli Ribas (Hospital Nuestra Señora de Meritxell, Andorra).

Author contributions

GM, AR, JSV, IML, ED and AT conceived and designed the study. All authors, apart from MR, LFR, JG, and AS, contributed to the acquisition and local preparation of the constituent database. GM, AR, EC, ST, IML, ED, JGM, LS, and JCY contributed to database creation and standardization, design of statistical analyses, and data analysis. GM, AR, LFR, JG, JSV, ED, MB, ST, JG, JCY, AS, JGM, LS, MVO, JMC, MVV, MIR, AT, and IML made important intellectual contributions and actively participated in the interpretation of the data and wrote the paper. All authors contributed to critical examination of the paper for important intellectual content and approval of the final manuscript.

Funding

This study was supported in part by grants from SEMICYUC (Spanish Society of Critical Care) and the Ricardo Barri Casanovas Foundation. The study sponsors had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding authors (AR/GM) had full access to all the data in the study and final responsibility for the decision to submit for publication.

Compliance with ethical standards

Conflicts of interest

All named authors declare that they have no conflicting interests.

Ethical approval

The institutional review board of Joan XXIII Hospital approved the original study (IRBRef#11809).

Supplementary material

134_2018_5332_MOESM1_ESM.docx (462 kb)
Supplementary material 1 (DOCX 461 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Gerard Moreno
    • 1
  • Alejandro Rodríguez
    • 1
    Email author
  • Luis F. Reyes
    • 2
    • 17
  • Josep Gomez
    • 1
  • Jordi Sole-Violan
    • 3
  • Emili Díaz
    • 4
  • María Bodí
    • 1
  • Sandra Trefler
    • 1
  • Juan Guardiola
    • 5
  • Juan C. Yébenes
    • 6
  • Alex Soriano
    • 7
  • José Garnacho-Montero
    • 8
  • Lorenzo Socias
    • 9
  • María del Valle Ortíz
    • 10
  • Eudald Correig
    • 11
  • Judith Marín-Corral
    • 12
  • Montserrat Vallverdú-Vidal
    • 13
  • Marcos I. Restrepo
    • 14
  • Antoni Torres
    • 15
  • Ignacio Martín-Loeches
    • 16
  • on behalf of the GETGAG Study Group
  1. 1.Critical Care Department URV/IISPV/CIBERESHospital Universitari de Tarragona Joan XXIIITarragonaSpain
  2. 2.Department of MicrobiologyUniversidad de La SabanaChiaColombia
  3. 3.Critical Care DepartmentHospital Dr. Negrín Gran CanariaLas PalmasSpain
  4. 4.Critical Care Department/CIBERESHospital Parc TaulíSabadellSpain
  5. 5.Division of Pulmonary, Critical Care and Sleep MedicineUniversity of Louisville and Robley Rex VA Medical CenterLouisvilleUSA
  6. 6.Critical Care DepartmentHospital de MataróMataróSpain
  7. 7.Hospital Clínic Infectious DiseasesHospital ClínicBarcelonaSpain
  8. 8.Critical Care Department, Hospital Universitario Virgen MacarenaInstituto de Biomedicina de Sevilla (IBIS)SevilleSpain
  9. 9.Critical Care DepartmentHospital Son LlàtzerPalmaSpain
  10. 10.Critical Care DepartmentHospital Universitario de BurgosBurgosSpain
  11. 11.Departamento de BioestadísticaUniversitat Rovira I VirgiliTarragonaSpain
  12. 12.Critical Care Department, Hospital Del MarResearch Group in Critical Disorders (GREPAC), IMIMBarcelonaSpain
  13. 13.Critical Care DepartmentHospital Universitari Arnau de VilanovaLleidaSpain
  14. 14.South Texas Veterans Health Care SystemUniversity of Texas Health Sciences at San AntonioTexasUSA
  15. 15.Hospital Clínic de Barcelona, Servei de Pneumologia i Al·lèrgia RespiratòriaInstitut Clínic del Tórax/CIBERESBarcelonaSpain
  16. 16.Department of Anaesthesia and Critical Care, St James ́s University Hospital, Trinity Centre for Health SciencesMultidisciplinary Intensive Care Research Organization (MICRO)DublinIreland
  17. 17.Department of Critical Care MedicineClinica Universidad de La SabanaChiaColombia

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