Corticosteroids for severe acute exacerbations of chronic obstructive pulmonary disease in intensive care: From the French OUTCOMEREA cohort.

Autor: Galerneau LM; Medical Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France.; HP2 laboratory, Grenoble Alpes University, INSERM U1300, Grenoble, France., Bailly S; HP2 laboratory, Grenoble Alpes University, INSERM U1300, Grenoble, France., Terzi N; Medical Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France.; HP2 laboratory, Grenoble Alpes University, INSERM U1300, Grenoble, France., Ruckly S; Department of Biostatistics, Outcomerea, Paris, France., Garrouste-Orgeas M; French and British Institute, Medical Unit, Levallois-Perret, France., Cohen Y; Intensive Care Unit, Avicenne Hospital, AP-HP, Paris, France., Hong Tuan Ha V; Medical Intensive Care Unit, Meaux hospital, Meaux, France., Gainnier M; Medical Intensive Care Unit, La Timone Hospital, Marseille, France., Siami S; Critical Care Medicine Unit, Etampes-Dourdan Hospital, Etampes, France., Dupuis C; Medical Intensive Care Unit, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France., Darmon M; Intensive Care Unit, Saint-Louis Hospital, AP-HP, Paris, France., Azoulay E; Intensive Care Unit, Saint-Louis Hospital, AP-HP, Paris, France., Forel JM; Medical Intensive Care Unit, Nord University Hospital, Marseille, France., Sigaud F; Medical Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France., Adrie C; Polyvalent Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France., Goldgran-Toledano D; Medical Intensive Care Unit, Le Raincy-Montfermeil Hospital, Montfermeil, France., Ferré A; Intensive Care Unit, Versailles Hospital, Le Chesnay, France., de Montmollin E; Medical and Infectious diseases Intensive Care Unit (MI2), Bichat Hospital, AP-HP, Paris, France.; IAME, University of Paris, INSERM U1137, University of Paris, F-75018, Paris, France., Argaud L; Medical Intensive Care Unit, Edouard Herriot Hospital, Lyon Civil Hospices, Lyon, France., Reignier J; Medical Intensive Care Unit, Nantes University Hospital, Nantes, France., Pepin JL; HP2 laboratory, Grenoble Alpes University, INSERM U1300, Grenoble, France., Timsit JF; Medical and Infectious diseases Intensive Care Unit (MI2), Bichat Hospital, AP-HP, Paris, France.; IAME, University of Paris, INSERM U1137, University of Paris, F-75018, Paris, France.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Apr 19; Vol. 18 (4), pp. e0284591. Date of Electronic Publication: 2023 Apr 19 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0284591
Abstrakt: Introduction: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a frequent cause of intensive care unit (ICU) admission. However, data are scarce and conflicting regarding the impact of systemic corticosteroid treatment in critically ill patients with acute exacerbation of COPD. The aim of the study was to assess the impact of systemic corticosteroids on the occurrence of death or need for continuous invasive mechanical ventilation at day 28 after ICU admission.
Methods: In the OutcomeReaTM prospective French national ICU database, we assessed the impact of corticosteroids at admission (daily dose ≥ 0.5 mg/kg of prednisone or equivalent during the first 24 hours ICU stay) on a composite outcome (death or invasive mechanical ventilation) using an inverse probability treatment weighting.
Results: Between January 1, 1997 and December 31, 2018, 391 out of 1,247 patients with acute exacerbations of COPDs received corticosteroids at ICU admission. Corticosteroids improved the main composite endpoint (OR = 0.70 [0.49; 0.99], p = 0.044. However, for the subgroup of most severe COPD patients, this did not occur (OR = 1.12 [0.53; 2.36], p = 0. 770). There was no significant impact of corticosteroids on rates of non-invasive ventilation failure, length of ICU or hospital stay, mortality or on the duration of mechanical ventilation. Patients on corticosteroids had the same prevalence of nosocomial infections as those without corticosteroids, but more glycaemic disorders.
Conclusion: Using systemic corticosteroids for acute exacerbation of COPD at ICU admission had a positive effect on a composite outcome defined by death or need for invasive mechanical ventilation at day 28.
Competing Interests: NT is supported by Pfizer for attending meetings and/or travel. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The other authors declare that they have no competing interests.
(Copyright: © 2023 Galerneau et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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