Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection
Identifieur interne : 002686 ( Main/Exploration ); précédent : 002685; suivant : 002687Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection
Auteurs : I. Martin-Loeches [Espagne] ; T. Lisboa [Espagne, Brésil] ; A. Rhodes [Royaume-Uni] ; R. P. Moreno [Portugal] ; E. Silva [Brésil] ; C. Sprung [Israël] ; J. D. Chiche [France] ; D. Barahona [Équateur] ; M. Villabon [Colombie] ; C. Balasini [Argentine] ; R. M. Pearse [Royaume-Uni] ; R. Matos [Portugal] ; J. Rello [Espagne, Canada]Source :
- Intensive Care Medicine [ 0342-4642 ] ; 2011-02-01.
English descriptors
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Abstract
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.
Url:
DOI: 10.1007/s00134-010-2078-z
Affiliations:
- Argentine, Brésil, Canada, Colombie, Espagne, France, Israël, Portugal, Royaume-Uni, Équateur
- Angleterre, Catalogne, Grand Londres, Rio Grande do Sul, État de São Paulo, Île-de-France
- Barcelone, Londres, Porto Alegre, Pris, São Paulo
- Université Paris-Descartes
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Rhodes</name><affiliation wicri:level="3"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Critical Care Department, St. George’s Healthcare NHS Trust, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Moreno, R P" sort="Moreno, R P" uniqKey="Moreno R" first="R. P." last="Moreno">R. P. Moreno</name><affiliation wicri:level="1"><country xml:lang="fr">Portugal</country><wicri:regionArea>Unidade de Cuidados Intensivos Polivalente, Hospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon</wicri:regionArea><wicri:noRegion>Lisbon</wicri:noRegion></affiliation></author><author><name sortKey="Silva, E" sort="Silva, E" uniqKey="Silva E" first="E." last="Silva">E. Silva</name><affiliation wicri:level="3"><country xml:lang="fr">Brésil</country><wicri:regionArea>ICU, Hospital Israelita Albert Einstein, São Paulo</wicri:regionArea><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Sprung, C" sort="Sprung, C" uniqKey="Sprung C" first="C." last="Sprung">C. Sprung</name><affiliation wicri:level="1"><country xml:lang="fr">Israël</country><wicri:regionArea>Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem</wicri:regionArea><wicri:noRegion>Jerusalem</wicri:noRegion></affiliation></author><author><name sortKey="Chiche, J D" sort="Chiche, J D" uniqKey="Chiche J" first="J. D." last="Chiche">J. D. Chiche</name><affiliation wicri:level="4"><country xml:lang="fr">France</country><wicri:regionArea>Service de Réanimation Médicale, Hôpital Cochin (AP-HP), Université Paris Descartes, Unité Inserm U567, 75014, Pris</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Pris</settlement></placeName><orgName type="university">Université Paris-Descartes</orgName></affiliation></author><author><name sortKey="Barahona, D" sort="Barahona, D" uniqKey="Barahona D" first="D." last="Barahona">D. Barahona</name><affiliation wicri:level="1"><country xml:lang="fr">Équateur</country><wicri:regionArea>Unidad de Cuidados Intensivos, Hospital Eugenio Espejo, Quito</wicri:regionArea><wicri:noRegion>Quito</wicri:noRegion></affiliation></author><author><name sortKey="Villabon, M" sort="Villabon, M" uniqKey="Villabon M" first="M." last="Villabon">M. Villabon</name><affiliation wicri:level="1"><country xml:lang="fr">Colombie</country><wicri:regionArea>Unidad de Cuidados Intensivos, Hospital de San José, Bogotá</wicri:regionArea><wicri:noRegion>Bogotá</wicri:noRegion></affiliation></author><author><name sortKey="Balasini, C" sort="Balasini, C" uniqKey="Balasini C" first="C." last="Balasini">C. Balasini</name><affiliation wicri:level="1"><country xml:lang="fr">Argentine</country><wicri:regionArea>Unidad de Cuidados Intensivos, Hospital San Martín, La Plata, Buenos Aires</wicri:regionArea><wicri:noRegion>Buenos Aires</wicri:noRegion></affiliation></author><author><name sortKey="Pearse, R M" sort="Pearse, R M" uniqKey="Pearse R" first="R. M." last="Pearse">R. M. Pearse</name><affiliation wicri:level="3"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Barts and The London School of Medicine and Dentistry, Queen Mary’s University of London Royal London Hospital, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Matos, R" sort="Matos, R" uniqKey="Matos R" first="R." last="Matos">R. Matos</name><affiliation wicri:level="1"><country xml:lang="fr">Portugal</country><wicri:regionArea>Unidade de Cuidados Intensivos Polivalente, Hospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon</wicri:regionArea><wicri:noRegion>Lisbon</wicri:noRegion></affiliation></author><author><name sortKey="Rello, J" sort="Rello, J" uniqKey="Rello J" first="J." last="Rello">J. Rello</name><affiliation wicri:level="3"><country xml:lang="fr">Espagne</country><wicri:regionArea>Critical Care Department, Vall d’Hebron University Hospital, Institut de Recerca Vall D’Hebron, University Autonoma Barcelona, CIBER Enfermedades Respiratorias (CIBERes), Passeig de la Vall d’Hebron 119-129, 08035, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation><affiliation wicri:level="1"><country wicri:rule="url">Canada</country></affiliation></author></analytic><monogr></monogr><series><title level="j">Intensive Care Medicine</title><title level="j" type="abbrev">Intensive Care Med</title><idno type="ISSN">0342-4642</idno><idno type="eISSN">1432-1238</idno><imprint><publisher>Springer-Verlag</publisher><pubPlace>Berlin/Heidelberg</pubPlace><date type="published" when="2011-02-01">2011-02-01</date><biblScope unit="volume">37</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="272">272</biblScope><biblScope unit="page" to="283">283</biblScope></imprint><idno type="ISSN">0342-4642</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0342-4642</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>ARDS</term><term>Community acquired pneumonia</term><term>Corticosteroid therapy</term><term>Pandemic (H1N1)v influenza A infection</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><affiliations><list><country><li>Argentine</li><li>Brésil</li><li>Canada</li><li>Colombie</li><li>Espagne</li><li>France</li><li>Israël</li><li>Portugal</li><li>Royaume-Uni</li><li>Équateur</li></country><region><li>Angleterre</li><li>Catalogne</li><li>Grand Londres</li><li>Rio Grande do Sul</li><li>État de São Paulo</li><li>Île-de-France</li></region><settlement><li>Barcelone</li><li>Londres</li><li>Porto Alegre</li><li>Pris</li><li>São Paulo</li></settlement><orgName><li>Université Paris-Descartes</li></orgName></list><tree><country name="Espagne"><noRegion><name sortKey="Martin Loeches, I" sort="Martin Loeches, I" uniqKey="Martin Loeches I" first="I." last="Martin-Loeches">I. Martin-Loeches</name></noRegion><name sortKey="Lisboa, T" sort="Lisboa, T" uniqKey="Lisboa T" first="T." last="Lisboa">T. Lisboa</name><name sortKey="Rello, J" sort="Rello, J" uniqKey="Rello J" first="J." last="Rello">J. Rello</name></country><country name="Brésil"><region name="Rio Grande do Sul"><name sortKey="Lisboa, T" sort="Lisboa, T" uniqKey="Lisboa T" first="T." last="Lisboa">T. Lisboa</name></region><name sortKey="Silva, E" sort="Silva, E" uniqKey="Silva E" first="E." last="Silva">E. Silva</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Rhodes, A" sort="Rhodes, A" uniqKey="Rhodes A" first="A." last="Rhodes">A. Rhodes</name></region><name sortKey="Pearse, R M" sort="Pearse, R M" uniqKey="Pearse R" first="R. M." last="Pearse">R. M. Pearse</name></country><country name="Portugal"><noRegion><name sortKey="Moreno, R P" sort="Moreno, R P" uniqKey="Moreno R" first="R. P." last="Moreno">R. P. Moreno</name></noRegion><name sortKey="Matos, R" sort="Matos, R" uniqKey="Matos R" first="R." last="Matos">R. Matos</name></country><country name="Israël"><noRegion><name sortKey="Sprung, C" sort="Sprung, C" uniqKey="Sprung C" first="C." last="Sprung">C. Sprung</name></noRegion></country><country name="France"><region name="Île-de-France"><name sortKey="Chiche, J D" sort="Chiche, J D" uniqKey="Chiche J" first="J. D." last="Chiche">J. D. Chiche</name></region></country><country name="Équateur"><noRegion><name sortKey="Barahona, D" sort="Barahona, D" uniqKey="Barahona D" first="D." last="Barahona">D. Barahona</name></noRegion></country><country name="Colombie"><noRegion><name sortKey="Villabon, M" sort="Villabon, M" uniqKey="Villabon M" first="M." last="Villabon">M. Villabon</name></noRegion></country><country name="Argentine"><noRegion><name sortKey="Balasini, C" sort="Balasini, C" uniqKey="Balasini C" first="C." last="Balasini">C. Balasini</name></noRegion></country><country name="Canada"><noRegion><name sortKey="Rello, J" sort="Rello, J" uniqKey="Rello J" first="J." last="Rello">J. Rello</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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