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      Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study

      research-article
      1 , 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 30 , 12 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 9 , 10 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 6 , 49 , 50 , 50 , 1 , 2 , , coVAPid Study Group
      Critical Care
      BioMed Central
      SARS-CoV-2, COVID-19, Ventilator-associated lower respiratory tract infections, Corticosteroids

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          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.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s13054-022-04170-2.

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          Most cited references32

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          Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

          Abstract Background Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. Methods In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the preliminary results of this comparison. Results A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55). Conclusions In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936; ISRCTN number, 50189673.)
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            Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China

            Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. Risk factors for the clinical outcomes of COVID-19 pneumonia have not yet been well delineated.
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              mice: Multivariate Imputation by Chained Equations inR

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                Author and article information

                Contributors
                s-nseir@chru-lille.fr
                Journal
                Crit Care
                Critical Care
                BioMed Central (London )
                1364-8535
                1466-609X
                27 September 2022
                27 September 2022
                2022
                : 26
                : 292
                Affiliations
                [1 ]GRID grid.410463.4, ISNI 0000 0004 0471 8845, Médecine Intensive-Réanimation, CHU de Lille, ; 59000 Lille, France
                [2 ]GRID grid.503422.2, ISNI 0000 0001 2242 6780, INSERM U1285, Université de Lille, CNRS, UMR 8576 – UGSF – Unité de Glycobiologie Structurale et Fonctionnelle, ; 59000 Lille, France
                [3 ]GRID grid.416409.e, ISNI 0000 0004 0617 8280, Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), , St. James’s Hospital, ; Dublin, Ireland
                [4 ]GRID grid.8217.c, ISNI 0000 0004 1936 9705, Department of Clinical Medicine, School of Medicine, , Trinity College Dublin, ; Dublin, Ireland
                [5 ]GRID grid.5841.8, ISNI 0000 0004 1937 0247, Hospital Clinic, IDIBAPS, , Universidad de Barcelona, Ciberes, ; Barcelona, Spain
                [6 ]GRID grid.414462.1, ISNI 0000 0001 1009 677X, Polyvalent Intensive Care Unit, , Hospital de São Francisco Xavier, CHLO, ; Lisbon, Portugal
                [7 ]GRID grid.10772.33, ISNI 0000000121511713, NOVA Medical School, CHRC, , New University of Lisbon, ; Lisbon, Portugal
                [8 ]GRID grid.7143.1, ISNI 0000 0004 0512 5013, Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, , OUH Odense University Hospital, ; Odense, Denmark
                [9 ]GRID grid.428313.f, ISNI 0000 0000 9238 6887, Critical Care Department, , Hospital Universitari Parc Tauli, ; Sabadell, Spain
                [10 ]GRID grid.7080.f, ISNI 0000 0001 2296 0625, Departament de Medicina, , Universitat Autonoma de Barcelona, ; Barcelona, Spain
                [11 ]GRID grid.134996.0, ISNI 0000 0004 0593 702X, Service de Médecine Intensive Réanimation, , CHU Amiens Picardie, ; 80000 Amiens, France
                [12 ]GRID grid.10403.36, ISNI 0000000091771775, Department of Pulmonology, , Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBERES, ; Barcelona, Spain
                [13 ]GRID grid.411149.8, ISNI 0000 0004 0472 0160, Department of Medical Intensive Care, , Caen University Hospital, ; 14000 Caen, France
                [14 ]GRID grid.418063.8, ISNI 0000 0004 0594 4203, Service de Réanimation Polyvalente, , Centre Hospitalier de Valenciennes, ; Valenciennes, France
                [15 ]GRID grid.41724.34, ISNI 0000 0001 2296 5231, Medical Intensive Care Unit, , Rouen University Hospital, UNIROUEN, Inserm U1096, FHU- REMOD-VHF, ; 76000 Rouen, France
                [16 ]GRID grid.31151.37, Department of Intensive Care, , François Mitterrand University Hospital, ; Dijon, France
                [17 ]GRID grid.489902.e, ISNI 0000 0004 0639 3677, Service de Réanimation et de Soins Intensifs, , Centre Hospitalier de Douai, ; Douai, France
                [18 ]GRID grid.411439.a, ISNI 0000 0001 2150 9058, Service de Médecine Intensive Réanimation, Institut de Cardiologie, , Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, ; Paris Cedex 13, France
                [19 ]GRID grid.477297.8, ISNI 0000 0004 0608 7784, Service de Réanimation, , Centre Hospitalier de Roubaix, ; Roubaix, France
                [20 ]GRID grid.488857.e, ISNI 0000 0000 9207 9326, Service de Médecine Intensive Réanimation, , Hôpital Saint Philibert GHICL, Université Catholique, ; Lille, France
                [21 ]GRID grid.11166.31, ISNI 0000 0001 2160 6368, CHU de Poitiers, Médecine Intensive Réanimation, CIC 1402 ALIVE, , Université de Poitiers, ; Poitiers, France
                [22 ]GRID grid.411296.9, ISNI 0000 0000 9725 279X, Department of Medical and Toxicological Critical Care, , Lariboisière Hospital, INSERM UMRS-1144, Paris Cité University, ; Paris, France
                [23 ]GRID grid.413328.f, ISNI 0000 0001 2300 6614, Service de Médecine Intensive Réanimation, , Hôpital Saint-Louis, ; 75010 Paris, France
                [24 ]National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
                [25 ]GRID grid.411784.f, ISNI 0000 0001 0274 3893, Medical Intensive Care Unit, , Cochin Hospital, Assistance Publique – Hôpitaux de Paris, ; Paris, France
                [26 ]GRID grid.5216.0, ISNI 0000 0001 2155 0800, First Department of Pulmonary Medicine and Intensive Care Unit, , National and Kapodistrian University of Athens, Sotiria Chest Hospital, ; Athens, Greece
                [27 ]GRID grid.470048.f, ISNI 0000 0004 0642 1236, Service de Réanimation Polyvalente, , Centre Hospitalier de Lens, ; Lens, France
                [28 ]GRID grid.277151.7, ISNI 0000 0004 0472 0371, Service de Médecine Intensive Réanimation, , CHU de Nantes, ; Nantes, France
                [29 ]GRID grid.411777.3, ISNI 0000 0004 1765 1563, Service de Médecine Intensive Réanimation, , CHU de Tours, Hôpital Bretonneau, ; 37044 Tours Cedex 9, France
                [30 ]GRID grid.412180.e, ISNI 0000 0001 2198 4166, Service de Médecine Intensive - Réanimation, , Hôpital Edouard Herriot, Hospices Civils de Lyon, ; 69437 Lyon Cedex 03, France
                [31 ]GRID grid.412370.3, ISNI 0000 0004 1937 1100, Service de Médecine Intensive Réanimation, , Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, ; 75012 Paris, France
                [32 ]GRID grid.413483.9, ISNI 0000 0001 2259 4338, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, , Hôpital Tenon, ; Paris, France
                [33 ]GRID grid.414474.6, ISNI 0000 0004 0639 3263, Service de Réanimation Polyvalente, , CH Victor Dupouy, ; Argenteuil, France
                [34 ]GRID grid.411439.a, ISNI 0000 0001 2150 9058, Service de Médecine Intensive-Réanimation et Pneumologie, , Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, ; Paris, France
                [35 ]GRID grid.411439.a, ISNI 0000 0001 2150 9058, Sorbonne Université, Inserm UMRS Neurophysiologie Respiratoire Expérimentale et Clinique, , Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, ; Paris, France
                [36 ]GRID grid.411147.6, ISNI 0000 0004 0472 0283, Département de Médecine Intensive Réanimation, , CHU d’Angers, ; 49933 Angers Cedex 9, France
                [37 ]GRID grid.42399.35, ISNI 0000 0004 0593 7118, Service de Médecine Intensive Réanimation, , CHU de Bordeaux, ; 33000 Bordeaux, France
                [38 ]GRID grid.412116.1, ISNI 0000 0001 2292 1474, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, ; 94010 Créteil, France
                [39 ]GRID grid.410511.0, ISNI 0000 0001 2149 7878, CARMAS, , Université Paris Est Créteil, ; 94010 Créteil, France
                [40 ]GRID grid.462410.5, ISNI 0000 0004 0386 3258, INSERM U955, , Institut Mondor de Recherche Biomédicale, ; 94010 Créteil, France
                [41 ]GRID grid.410558.d, ISNI 0000 0001 0035 6670, Intensive Care Unit, University Hospital of Larissa, , University of Thessaly, Biopolis, ; 41110 Larissa, Greece
                [42 ]Intensive Care Unit, Hôpital de Béthune, 62408 Béthune, France
                [43 ]Service de Réanimation, Hôpital Duchenne, 62200 Boulogne-sur-Mer, France
                [44 ]GRID grid.462844.8, ISNI 0000 0001 2308 1657, Département de Neurologie, Unité de Médecine Intensive Réanimation Neurologique, , Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, ; Paris, France
                [45 ]GRID grid.462844.8, ISNI 0000 0001 2308 1657, Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de Recherche Saint-Antoine, Maladies Métaboliques, Biliaires et Fibro-Inflammatoire du Foie, Institute of Cardiometabolism and Nutrition (ICAN), , Sorbonne Université, ; Paris, France
                [46 ]GRID grid.462844.8, ISNI 0000 0001 2308 1657, Groupe de Recherche Clinique en Réanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE), , Sorbonne Université, ; Paris, France
                [47 ]GRID grid.414615.3, ISNI 0000 0004 0426 8215, Intensive Care Unit, , Hospital Universitari Sagrat Cor, Grupo Quironsalud, ; Barcelona, Spain
                [48 ]GRID grid.7080.f, ISNI 0000 0001 2296 0625, Critical Care Center, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, , Autonomous University of Barcelona, ; Sabadell, Spain
                [49 ]GRID grid.503422.2, ISNI 0000 0001 2242 6780, Univ. Lille, ULR 2694-METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, ; 59000 Lille, France
                [50 ]GRID grid.410463.4, ISNI 0000 0004 0471 8845, Biostatistics Department, , CHU de Lille, ; 59000 Lille, France
                Article
                4170
                10.1186/s13054-022-04170-2
                9513297
                34980198
                6455509e-5bbd-4401-be89-ae01d324a8ac
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 13 July 2022
                : 12 September 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001602, Science Foundation Ireland;
                Award ID: 20/COV/0038
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100001665, Agence Nationale de la Recherche;
                Award ID: coVAPid Project
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                Emergency medicine & Trauma
                sars-cov-2,covid-19,ventilator-associated lower respiratory tract infections,corticosteroids

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