TY - JOUR
T1 - Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients :
T2 - a retrospective multicenter study
AU - Saura, Ouriel
AU - Rouzé, Anahita
AU - Martin-Loeches, Ignacio
AU - Povoa, Pedro
AU - Kreitmann, Louis
AU - Torres, Antoni
AU - Metzelard, Matthieu
AU - Du Cheyron, Damien
AU - Lambiotte, Fabien
AU - Tamion, Fabienne
AU - Labruyere, Marie
AU - Boulle Geronimi, Claire
AU - Luyt, Charles-Edouard
AU - Nyunga, Martine
AU - Pouly, Olivier
AU - Thille, Arnaud W.
AU - Megarbane, Bruno
AU - Saade, Anastasia
AU - Magira, Eleni
AU - Llitjos, Jean-François
AU - Ioannidou, Iliana
AU - Pierre, Alexandre
AU - Reignier, Jean
AU - Garot, Denis
AU - Baudel, Jean-Luc
AU - Voiriot, Guillaume
AU - Plantefeve, Gaëtan
AU - Morawiec, Elise
AU - Asfar, Pierre
AU - Boyer, Alexandre
AU - Mekontso-Dessap, Armand
AU - Bardaka, Fotini
AU - Díaz Santos, Emilio
AU - Vinsonneau, Christophe
AU - Floch, Pierre-Edouard
AU - Weiss, Nicolas
AU - Ceccato, Adrian
AU - Artigas Raventós, Antoni
AU - Nora, David
AU - Duhamel, Alain
AU - Labreuche, Julien
AU - Nseir, Saad
PY - 2022
Y1 - 2022
N2 - 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.
AB - 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.
KW - Corticosteroids
KW - COVID-19
KW - SARS-CoV-2
KW - Ventilator-associated lower respiratory tract infections
U2 - 10.1186/s13054-022-04170-2
DO - 10.1186/s13054-022-04170-2
M3 - Article
C2 - 36167550
SN - 1466-609X
VL - 26
JO - Critical Care
JF - Critical Care
ER -