Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study
| Autor: | Saura, Ouriel, Rouzé, Anahita, Martin Loeches, Ignacio, Povoa, Pedro, Kreitmann, Louis, Torres Martí, Antoni, Metzelard, Matthieu, Du Cheyron, Damien, Lambiotte, Fabien, Tamion, Fabienne, Labruyere, Marie, Boulle Geronimi, Claire, Luyt, Charles-Edouard, Nyunga, Martine, Pouly, Olivier, Thille, Arnaud Wilfrid, Megarbane, Bruno, Saade, Anastasia, Magira, Eleni, Llitjos, Jean-François, Ioannidou, Iliana, Pierre, Alexandre, Reignier, Jean, Garot, Denis, Baudel, Jean-Luc, Voiriot, Guillaume, Plantefeve, Gaëtan, Morawiec, Elise, Asfar, Pierre, Boyer, Alexandre, Mekontso-Dessap, Armand, Bardaka, Fotini, Diaz, Emili, Vinsonneau, Christophe, Floch, Pierre-Edouard, Weiss, Nicolas, Ceccato, Adrian, Artigas, Antonio, Nora, David, Duhamel, Alain, Labreuche, Julien, Nseir, Saad, coVAPid Study Group |
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| Jazyk: | angličtina |
| Rok vydání: | 2023 |
| Předmět: |
Adult
SARS-CoV-2 Respiradors Incidence Adrenocortical hormones Pneumonia Ventilator-Associated COVID-19 Respiratory infections Pneumònia Pneumonia Critical Care and Intensive Care Medicine Corticosteroides Infeccions respiratòries Respiració artificial Respiration Artificial Respirators Intensive Care Units Artificial respiration Humans Retrospective Studies |
| Popis: | Background Ventilator-associated pneumonia (VAP) is common in patients with severe SARS-CoV-2 pneumonia. The aim of this ancillary analysis of the coVAPid multicenter observational retrospective study is to assess the relationship between adjuvant corticosteroid use and the incidence of VAP. Methods Planned ancillary analysis of a multicenter retrospective European cohort in 36 ICUs. Adult patients receiving invasive mechanical ventilation for more than 48 h for SARS-CoV-2 pneumonia were consecutively included between February and May 2020. VAP diagnosis required strict definition with clinical, radiological and quantitative microbiological confirmation. We assessed the association of VAP with corticosteroid treatment using univariate and multivariate cause-specific Cox’s proportional hazard models with adjustment on pre-specified confounders. Results Among the 545 included patients, 191 (35%) received corticosteroids. The proportional hazard assumption for the effect of corticosteroids on the incidence of VAP could not be accepted, indicating that this effect varied during ICU stay. We found a non-significant lower risk of VAP for corticosteroid-treated patients during the first days in the ICU and an increased risk for longer ICU stay. By modeling the effect of corticosteroids with time-dependent coefficients, the association between corticosteroids and the incidence of VAP was not significant (overall effect p = 0.082), with time-dependent hazard ratios (95% confidence interval) of 0.47 (0.17–1.31) at day 2, 0.95 (0.63–1.42) at day 7, 1.48 (1.01–2.16) at day 14 and 1.94 (1.09–3.46) at day 21. Conclusions No significant association was found between adjuvant corticosteroid treatment and the incidence of VAP, although a time-varying effect of corticosteroids was identified along the 28-day follow-up. |
| Databáze: | OpenAIRE |
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