Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study.
COVID-19
Corticosteroids
SARS-CoV-2
Ventilator-associated lower respiratory tract infections
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
27 09 2022
27 09 2022
Historique:
received:
13
07
2022
accepted:
12
09
2022
entrez:
27
9
2022
pubmed:
28
9
2022
medline:
30
9
2022
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 36167550
doi: 10.1186/s13054-022-04170-2
pii: 10.1186/s13054-022-04170-2
pmc: PMC9513297
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
292Subventions
Organisme : Science Foundation Ireland
ID : 20/COV/0038
Pays : Ireland
Organisme : Agence Nationale de la Recherche
ID : coVAPid Project
Investigateurs
Mathilde Bouchereau
(M)
Sean Boyd
(S)
Luis Coelho
(L)
Julien Maizel
(J)
Pierre Cuchet
(P)
Wafa Zarrougui
(W)
Déborah Boyer
(D)
Jean-Pierre Quenot
(JP)
Mehdi Imouloudene
(M)
Marc Pineton de Chambrun
(M)
Thierry Van der Linden
(T)
François Arrive
(F)
Sebastian Voicu
(S)
Elie Azoulay
(E)
Edgard Moglia
(E)
Frédéric Pene
(F)
Catia Cilloniz
(C)
Didier Thevenin
(D)
Charlotte Larrat
(C)
Laurent Argaud
(L)
Bertrand Guidet
(B)
Damien Contou
(D)
Alexandra Beurton
(A)
David Meguerditchian
(D)
Keyvan Razazi
(K)
Vassiliki Tsolaki
(V)
Mehdi Marzouk
(M)
Guillaume Brunin
(G)
Clémence Marois
(C)
Luis Morales
(L)
Informations de copyright
© 2022. The Author(s).
Références
N Engl J Med. 2021 Feb 25;384(8):693-704
pubmed: 32678530
Circulation. 2016 Feb 9;133(6):601-9
pubmed: 26858290
Crit Care. 2021 Jul 6;25(1):235
pubmed: 34229747
Ann Intensive Care. 2021 May 25;11(1):83
pubmed: 34036411
Crit Care. 2022 Aug 3;26(1):236
pubmed: 35922860
Intensive Care Med. 2021 Jan;47(1):60-73
pubmed: 33211135
Crit Care. 2021 Jan 11;25(1):25
pubmed: 33430915
Curr Opin Crit Care. 2021 Oct 1;27(5):468-473
pubmed: 34321415
J Steroid Biochem. 1980 Jan;12:445-9
pubmed: 6968381
Microorganisms. 2022 May 08;10(5):
pubmed: 35630429
Biometrics. 1978 Dec;34(4):541-54
pubmed: 373811
Lancet Respir Med. 2022 Sep;10(9):888-899
pubmed: 35617986
Lancet Respir Med. 2015 Nov;3(11):859-68
pubmed: 26472037
Crit Care. 2021 May 25;25(1):177
pubmed: 34034777
Chest. 2021 Aug;160(2):454-465
pubmed: 33857475
Am J Respir Crit Care Med. 2022 Jul 15;206(2):161-169
pubmed: 35537122
Clin Infect Dis. 2020 Jul 28;71(15):762-768
pubmed: 32161940
BMC Infect Dis. 2019 Feb 12;19(1):145
pubmed: 30755175
JAMA. 2020 Oct 6;324(13):1330-1341
pubmed: 32876694
J Infect. 2022 Jul;85(1):57-63
pubmed: 35605805
Ann Intensive Care. 2021 May 31;11(1):87
pubmed: 34057642
Int J Biol Sci. 2020 Jul 9;16(14):2479-2489
pubmed: 32792851
Signal Transduct Target Ther. 2020 Mar 27;5(1):33
pubmed: 32296069
Intensive Care Med. 2021 Feb;47(2):188-198
pubmed: 33388794
Crit Care Med. 2022 May 1;50(5):825-836
pubmed: 35148524
Intensive Care Med. 2020 Dec;46(12):2168-2183
pubmed: 33175277
Crit Care. 2022 Aug 2;26(1):233
pubmed: 35918776
JAMA Intern Med. 2020 Jul 1;180(7):934-943
pubmed: 32167524
Crit Care. 2020 Dec 14;24(1):696
pubmed: 33317589
Crit Care. 2020 Dec 18;24(1):699
pubmed: 33339526
J Clin Med. 2021 Feb 03;10(4):
pubmed: 33546093
Br J Anaesth. 2009 Jul;103(1):70-81
pubmed: 19474216
Mol Med. 2008 Jan-Feb;14(1-2):64-78
pubmed: 18026569