Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients : a retrospective multicenter study
Saura, Ouriel (CHU de Lille)
Rouzé, Anahita (Université de Lille)
Martin-Loeches, Ignacio (Hospital Clínic i Provincial de Barcelona)
Povoa, Pedro (Odense University Hospital (Dinamarca))
Kreitmann, Louis (Hôpital Edouard Herriot)
Torres, Antoni (Hospital Clínic i Provincial de Barcelona)
Metzelard, Matthieu (CHU Amiens Picardie)
Du Cheyron, Damien (Caen University Hospital (França))
Lambiotte, Fabien (Centre Hospitalier de Valenciennes)
Tamion, Fabienne (Rouen University Hospital (França))
Labruyere, Marie (François Mitterrand University Hospital)
Boulle Geronimi, Claire (Centre Hospitalier de Douai)
Luyt, Charles-Edouard (Groupe Hospitalier Pitié-Salpêtrière)
Nyunga, Martine (Centre Hospitalier de Roubaix)
Pouly, Olivier (Hôpital Saint Philibert GHICL)
Thille, Arnaud W. (Université de Poitiers)
Mégarbane, Bruno (Lariboisière Hospital)
Saade, Anastasia (Hôpital Saint-Louis)
Magira, Eleni (National and Kapodistrian University of Athens)
Llitjos, Jean-François (Hôpitaux de Paris)
Ioannidou, Iliana (National and Kapodistrian University of Athens)
Pierre, Alexandre (Centre Hospitalier de Lens)
Reignier, Jean (CHU de Nantes)
Garot, Denis (CHU de Tours)
Baudel, Jean-Luc (Hôpital Saint-Antoine)
Voiriot, Guillaume (Hôpital Tenon)
Plantefeve, Gaëtan (CH Victor Dupouy)
Morawiec, Elise (Assistance Publique-Hôpitaux de Paris)
Asfar, Pierre (CHU d'Angers)
Boyer, Alexandre (CHU de Bordeaux)
Mekontso-Dessap, Armand (Institut Mondor de Recherche Biomédicale)
Bardaka, Fotini (University of Thessaly)
Díaz Santos, Emilio (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Vinsonneau, Christophe (Hôpital de Béthune)
Floch, Pierre-Edouard (Hôpital Duchenne)
Weiss, Nicolas (Sorbonne Université)
Ceccato, Adrian (Hospital del Sagrat Cor (Barcelona, Catalunya))
Artigas Raventós, Antoni (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Nora, David (Hospital de São Francisco Xavier (Lisboa, Portugal))
Duhamel, Alain (CHU de Lille)
Labreuche, Julien (CHU de Lille)
Nseir, Saad (Université de Lille)
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	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. The online version contains supplementary material available at 10. 1186/s13054-022-04170-2.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Corticosteroids ; COVID-19 ; SARS-CoV-2 ; Ventilator-associated lower respiratory tract infections
Published in:	Critical Care, Vol. 26 (september 2022) , ISSN 1466-609X

DOI: 10.1186/s13054-022-04170-2
PMID: 36167550

11 p, 1.1 MB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Parc Taulí Research and Innovation Institute (I3PT
Articles > Research articles
Articles > Published articles