Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients : a retrospective multicenter study
© 2022. The Author(s)..
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.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:26 |
|---|---|
| Enthalten in: |
Critical care (London, England) - 26(2022), 1 vom: 27. Sept., Seite 292 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Saura, Ouriel [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
COVID-19 |
|---|
| Anmerkungen: |
Date Completed 29.09.2022 Date Revised 28.10.2022 published: Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1186/s13054-022-04170-2 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM346831644 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM346831644 | ||
| 003 | DE-627 | ||
| 005 | 20231226032406.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2022 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1186/s13054-022-04170-2 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1156.xml |
| 035 | |a (DE-627)NLM346831644 | ||
| 035 | |a (NLM)36167550 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Saura, Ouriel |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients |b a retrospective multicenter study |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 29.09.2022 | ||
| 500 | |a Date Revised 28.10.2022 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022. The Author(s). | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Corticosteroids | |
| 650 | 4 | |a SARS-CoV-2 | |
| 650 | 4 | |a Ventilator-associated lower respiratory tract infections | |
| 700 | 1 | |a Rouzé, Anahita |e verfasserin |4 aut | |
| 700 | 1 | |a Martin-Loeches, Ignacio |e verfasserin |4 aut | |
| 700 | 1 | |a Povoa, Pedro |e verfasserin |4 aut | |
| 700 | 1 | |a Kreitmann, Louis |e verfasserin |4 aut | |
| 700 | 1 | |a Torres, Antoni |e verfasserin |4 aut | |
| 700 | 1 | |a Metzelard, Matthieu |e verfasserin |4 aut | |
| 700 | 1 | |a Du Cheyron, Damien |e verfasserin |4 aut | |
| 700 | 1 | |a Lambiotte, Fabien |e verfasserin |4 aut | |
| 700 | 1 | |a Tamion, Fabienne |e verfasserin |4 aut | |
| 700 | 1 | |a Labruyere, Marie |e verfasserin |4 aut | |
| 700 | 1 | |a Boulle Geronimi, Claire |e verfasserin |4 aut | |
| 700 | 1 | |a Luyt, Charles-Edouard |e verfasserin |4 aut | |
| 700 | 1 | |a Nyunga, Martine |e verfasserin |4 aut | |
| 700 | 1 | |a Pouly, Olivier |e verfasserin |4 aut | |
| 700 | 1 | |a Thille, Arnaud W |e verfasserin |4 aut | |
| 700 | 1 | |a Megarbane, Bruno |e verfasserin |4 aut | |
| 700 | 1 | |a Saade, Anastasia |e verfasserin |4 aut | |
| 700 | 1 | |a Magira, Eleni |e verfasserin |4 aut | |
| 700 | 1 | |a Llitjos, Jean-François |e verfasserin |4 aut | |
| 700 | 1 | |a Ioannidou, Iliana |e verfasserin |4 aut | |
| 700 | 1 | |a Pierre, Alexandre |e verfasserin |4 aut | |
| 700 | 1 | |a Reignier, Jean |e verfasserin |4 aut | |
| 700 | 1 | |a Garot, Denis |e verfasserin |4 aut | |
| 700 | 1 | |a Baudel, Jean-Luc |e verfasserin |4 aut | |
| 700 | 1 | |a Voiriot, Guillaume |e verfasserin |4 aut | |
| 700 | 1 | |a Plantefeve, Gaëtan |e verfasserin |4 aut | |
| 700 | 1 | |a Morawiec, Elise |e verfasserin |4 aut | |
| 700 | 1 | |a Asfar, Pierre |e verfasserin |4 aut | |
| 700 | 1 | |a Boyer, Alexandre |e verfasserin |4 aut | |
| 700 | 1 | |a Mekontso-Dessap, Armand |e verfasserin |4 aut | |
| 700 | 1 | |a Bardaka, Fotini |e verfasserin |4 aut | |
| 700 | 1 | |a Diaz, Emili |e verfasserin |4 aut | |
| 700 | 1 | |a Vinsonneau, Christophe |e verfasserin |4 aut | |
| 700 | 1 | |a Floch, Pierre-Edouard |e verfasserin |4 aut | |
| 700 | 1 | |a Weiss, Nicolas |e verfasserin |4 aut | |
| 700 | 1 | |a Ceccato, Adrian |e verfasserin |4 aut | |
| 700 | 1 | |a Artigas, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Nora, David |e verfasserin |4 aut | |
| 700 | 1 | |a Duhamel, Alain |e verfasserin |4 aut | |
| 700 | 1 | |a Labreuche, Julien |e verfasserin |4 aut | |
| 700 | 1 | |a Nseir, Saad |e verfasserin |4 aut | |
| 700 | 0 | |a coVAPid Study Group |e verfasserin |4 aut | |
| 700 | 1 | |a Bouchereau, Mathilde |e investigator |4 oth | |
| 700 | 1 | |a Boyd, Sean |e investigator |4 oth | |
| 700 | 1 | |a Coelho, Luis |e investigator |4 oth | |
| 700 | 1 | |a Maizel, Julien |e investigator |4 oth | |
| 700 | 1 | |a Cuchet, Pierre |e investigator |4 oth | |
| 700 | 1 | |a Zarrougui, Wafa |e investigator |4 oth | |
| 700 | 1 | |a Boyer, Déborah |e investigator |4 oth | |
| 700 | 1 | |a Quenot, Jean-Pierre |e investigator |4 oth | |
| 700 | 1 | |a Imouloudene, Mehdi |e investigator |4 oth | |
| 700 | 1 | |a Pineton de Chambrun, Marc |e investigator |4 oth | |
| 700 | 1 | |a Van der Linden, Thierry |e investigator |4 oth | |
| 700 | 1 | |a Arrive, François |e investigator |4 oth | |
| 700 | 1 | |a Voicu, Sebastian |e investigator |4 oth | |
| 700 | 1 | |a Azoulay, Elie |e investigator |4 oth | |
| 700 | 1 | |a Moglia, Edgard |e investigator |4 oth | |
| 700 | 1 | |a Pene, Frédéric |e investigator |4 oth | |
| 700 | 1 | |a Cilloniz, Catia |e investigator |4 oth | |
| 700 | 1 | |a Thevenin, Didier |e investigator |4 oth | |
| 700 | 1 | |a Larrat, Charlotte |e investigator |4 oth | |
| 700 | 1 | |a Argaud, Laurent |e investigator |4 oth | |
| 700 | 1 | |a Guidet, Bertrand |e investigator |4 oth | |
| 700 | 1 | |a Contou, Damien |e investigator |4 oth | |
| 700 | 1 | |a Beurton, Alexandra |e investigator |4 oth | |
| 700 | 1 | |a Meguerditchian, David |e investigator |4 oth | |
| 700 | 1 | |a Razazi, Keyvan |e investigator |4 oth | |
| 700 | 1 | |a Tsolaki, Vassiliki |e investigator |4 oth | |
| 700 | 1 | |a Marzouk, Mehdi |e investigator |4 oth | |
| 700 | 1 | |a Brunin, Guillaume |e investigator |4 oth | |
| 700 | 1 | |a Marois, Clémence |e investigator |4 oth | |
| 700 | 1 | |a Morales, Luis |e investigator |4 oth | |
| 773 | 0 | 8 | |i Enthalten in |t Critical care (London, England) |d 1997 |g 26(2022), 1 vom: 27. Sept., Seite 292 |w (DE-627)NLM097399787 |x 1466-609X |7 nnns |
| 773 | 1 | 8 | |g volume:26 |g year:2022 |g number:1 |g day:27 |g month:09 |g pages:292 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1186/s13054-022-04170-2 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 26 |j 2022 |e 1 |b 27 |c 09 |h 292 | ||