Pre-Admission Oral Corticosteroids are Associated with Reduced Risk of Acute Respiratory Distress Syndrome in Critically Ill Adults with Sepsis

Abstract

Objective

To determine the association between pre-admission oral corticosteroid receipt and the development of acute respiratory distress syndrome in critically ill patients with sepsis.

Design

Retrospective observational study.

Patients

A total of 1,080 critically ill patients with sepsis in an academic tertiary care hospital.

Interventions

None.

Measurements and Main Results

The unadjusted incidence of ARDS within 96 hours of ICU admission was 35% among patients who had received oral corticosteroids compared with 42% among those who had not (p=0.107). In a multivariable analysis controlling for pre-specified confounders, pre-admission oral corticosteroids were associated with a lower incidence of ARDS in the 96 hours after ICU admission (OR 0.53, 95% CI 0.33 – 0.84, p=0.008), a finding that persisted in multiple sensitivity analyses. The median daily dose of oral corticosteroids among the 165 patients receiving oral corticosteroids, in prednisone equivalents, was 10 mg [IQR 5 – 30 mg]. Higher doses of pre-admission oral corticosteroids were associated with a lower incidence of ARDS (OR for 30 mg of prednisone compared with 5 mg 0.53, 95% CI 0.32 – 0.86). In multivariable analyses, pre-admission oral corticosteroids were not associated with in-hospital mortality (OR 1.41, 95% CI 0.87 – 2.28, p=0.164), ICU length of stay (OR 0.90, 95% CI 0.63 - 1.30, p=0.585), or ventilator-free days (OR 1.06, 95% CI 0.71 – 1.57, p=0.783).

Conclusions

Among ICU patients with sepsis, pre-admission oral corticosteroids were independently associated with a lower incidence of early ARDS.