Critical Care (Sep 2022)
Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study
- Ouriel Saura,
- Anahita Rouzé,
- Ignacio Martin-Loeches,
- Pedro Povoa,
- Louis Kreitmann,
- Antoni Torres,
- Matthieu Metzelard,
- Damien Du Cheyron,
- Fabien Lambiotte,
- Fabienne Tamion,
- Marie Labruyere,
- Claire Boulle Geronimi,
- Charles-Edouard Luyt,
- Martine Nyunga,
- Olivier Pouly,
- Arnaud W. Thille,
- Bruno Megarbane,
- Anastasia Saade,
- Eleni Magira,
- Jean-François Llitjos,
- Iliana Ioannidou,
- Alexandre Pierre,
- Jean Reignier,
- Denis Garot,
- Jean-Luc Baudel,
- Guillaume Voiriot,
- Gaëtan Plantefeve,
- Elise Morawiec,
- Pierre Asfar,
- Alexandre Boyer,
- Armand Mekontso-Dessap,
- Fotini Bardaka,
- Emili Diaz,
- Christophe Vinsonneau,
- Pierre-Edouard Floch,
- Nicolas Weiss,
- Adrian Ceccato,
- Antonio Artigas,
- David Nora,
- Alain Duhamel,
- Julien Labreuche,
- Saad Nseir,
- coVAPid Study Group
Affiliations
- Ouriel Saura
- Médecine Intensive-Réanimation, CHU de Lille
- Anahita Rouzé
- Médecine Intensive-Réanimation, CHU de Lille
- Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s Hospital
- Pedro Povoa
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO
- Louis Kreitmann
- Service de Médecine Intensive - Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon
- Antoni Torres
- Department of Pulmonology, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBERES
- Matthieu Metzelard
- Service de Médecine Intensive Réanimation, CHU Amiens Picardie
- Damien Du Cheyron
- Department of Medical Intensive Care, Caen University Hospital
- Fabien Lambiotte
- Service de Réanimation Polyvalente, Centre Hospitalier de Valenciennes
- Fabienne Tamion
- Medical Intensive Care Unit, Rouen University Hospital, UNIROUEN, Inserm U1096, FHU- REMOD-VHF
- Marie Labruyere
- Department of Intensive Care, François Mitterrand University Hospital
- Claire Boulle Geronimi
- Service de Réanimation et de Soins Intensifs, Centre Hospitalier de Douai
- Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris
- Martine Nyunga
- Service de Réanimation, Centre Hospitalier de Roubaix
- Olivier Pouly
- Service de Médecine Intensive Réanimation, Hôpital Saint Philibert GHICL, Université Catholique
- Arnaud W. Thille
- CHU de Poitiers, Médecine Intensive Réanimation, CIC 1402 ALIVE, Université de Poitiers
- Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris Cité University
- Anastasia Saade
- Service de Médecine Intensive Réanimation, Hôpital Saint-Louis
- Eleni Magira
- National and Kapodistrian University of Athens, Evangelismos Hospital
- Jean-François Llitjos
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique – Hôpitaux de Paris
- Iliana Ioannidou
- First Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Sotiria Chest Hospital
- Alexandre Pierre
- Service de Réanimation Polyvalente, Centre Hospitalier de Lens
- Jean Reignier
- Service de Médecine Intensive Réanimation, CHU de Nantes
- Denis Garot
- Service de Médecine Intensive Réanimation, CHU de Tours, Hôpital Bretonneau
- Jean-Luc Baudel
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris
- Guillaume Voiriot
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon
- Gaëtan Plantefeve
- Service de Réanimation Polyvalente, CH Victor Dupouy
- Elise Morawiec
- Service de Médecine Intensive-Réanimation et Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière
- Pierre Asfar
- Département de Médecine Intensive Réanimation, CHU d’Angers
- Alexandre Boyer
- Service de Médecine Intensive Réanimation, CHU de Bordeaux
- Armand Mekontso-Dessap
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation
- Fotini Bardaka
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly, Biopolis
- Emili Diaz
- Critical Care Department, Hospital Universitari Parc Tauli
- Christophe Vinsonneau
- Intensive Care Unit, Hôpital de Béthune
- Pierre-Edouard Floch
- Service de Réanimation, Hôpital Duchenne
- Nicolas Weiss
- Département de Neurologie, Unité de Médecine Intensive Réanimation Neurologique, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière
- Adrian Ceccato
- Intensive Care Unit, Hospital Universitari Sagrat Cor, Grupo Quironsalud
- Antonio Artigas
- Critical Care Center, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona
- David Nora
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO
- Alain Duhamel
- Univ. Lille, ULR 2694-METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales
- Julien Labreuche
- Biostatistics Department, CHU de Lille
- Saad Nseir
- Médecine Intensive-Réanimation, CHU de Lille
- coVAPid Study Group
- DOI
- https://doi.org/10.1186/s13054-022-04170-2
- Journal volume & issue
-
Vol. 26,
no. 1
pp. 1 – 11
Abstract
Abstract 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.
Keywords
