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      Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection

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          Abstract

          Introduction

          Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial.

          Methods

          Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry.

          Results

          Two hundred twenty patients admitted to an intensive care unit (ICU) with completed outcome data were analyzed. Invasive mechanical ventilation was used in 155 (70.5%). Sixty-seven (30.5%) of the patients died in ICU and 75 (34.1%) whilst in hospital. One hundred twenty-six (57.3%) patients received corticosteroid therapy on admission to ICU. Patients who received corticosteroids were significantly older and were more likely to have coexisting asthma, chronic obstructive pulmonary disease (COPD), and chronic steroid use. These patients receiving corticosteroids had increased likelihood of developing hospital-acquired pneumonia (HAP) [26.2% versus 13.8%, p < 0.05; odds ratio (OR) 2.2, confidence interval (CI) 1.1–4.5]. Patients who received corticosteroids had significantly higher ICU mortality than patients who did not (46.0% versus 18.1%, p < 0.01; OR 3.8, CI 2.1–7.2). Cox regression analysis adjusted for severity and potential confounding factors identified that early use of corticosteroids was not significantly associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7–2.4, p = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0–4.8, p < 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed.

          Conclusions

          Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections.

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          Most cited references30

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          Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People's Republic of China, in February, 2003

          Summary Background An epidemic of severe acute respiratory syndrome (SARS) has been associated with an outbreak of atypical pneumonia originating in Guangdong Province, People's Republic of China. We aimed to identify the causative agent in the Guangdong outbreak and describe the emergence and spread of the disease within the province. Methods We analysed epidemiological information and collected serum and nasopharyngeal aspirates from patients with SARS in Guangdong in mid-February, 2003. We did virus isolation, serological tests, and molecular assays to identify the causative agent. Findings SARS had been circulating in other cities of Guangdong Province for about 2 months before causing a major outbreak in Guangzhou, the province's capital. A novel coronavirus, SARS coronavirus (CoV), was isolated from specimens from three patients with SARS. Viral antigens were also directly detected in nasopharyngeal aspirates from these patients. 48 of 55 (87%) patients had antibodies to SARS CoV in their convalescent sera. Genetic analysis showed that the SARS CoV isolates from Guangzhou shared the same origin with those in other countries, and had a phylogenetic pathway that matched the spread of SARS to the other parts of the world. Interpretation SARS CoV is the infectious agent responsible for the epidemic outbreak of SARS in Guangdong. The virus isolated from patients in Guangdong is the prototype of the SARS CoV in other regions and countries.
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            SAPS 3—From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission

            Objective To develop a model to assess severity of illness and predict vital status at hospital discharge based on ICU admission data. Design Prospective multicentre, multinational cohort study. Patients and setting A total of 16,784 patients consecutively admitted to 303 intensive care units from 14 October to 15 December 2002. Measurements and results ICU admission data (recorded within ±1 h) were used, describing: prior chronic conditions and diseases; circumstances related to and physiologic derangement at ICU admission. Selection of variables for inclusion into the model used different complementary strategies. For cross-validation, the model-building procedure was run five times, using randomly selected four fifths of the sample as a development- and the remaining fifth as validation-set. Logistic regression methods were then used to reduce complexity of the model. Final estimates of regression coefficients were determined by use of multilevel logistic regression. Variables selection and weighting were further checked by bootstraping (at patient level and at ICU level). Twenty variables were selected for the final model, which exhibited good discrimination (aROC curve 0.848), without major differences across patient typologies. Calibration was also satisfactory (Hosmer-Lemeshow goodness-of-fit test Ĥ=10.56, p=0.39, Ĉ=14.29, p=0.16). Customised equations for major areas of the world were computed and demonstrate a good overall goodness-of-fit. Conclusions The SAPS 3 admission score is able to predict vital status at hospital discharge with use of data recorded at ICU admission. Furthermore, SAPS 3 conceptually dissociates evaluation of the individual patient from evaluation of the ICU and thus allows them to be assessed at their respective reference levels. Electronic Supplementary Material Electronic supplementary material is included in the online fulltext version of this article and accessible for authorised users: http://dx.doi.org/10.1007/s00134-005-2763-5
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              Critically Ill patients with 2009 influenza A(H1N1) in Mexico.

              In March 2009, novel 2009 influenza A(H1N1) was first reported in the southwestern United States and Mexico. The population and health care system in Mexico City experienced the first and greatest early burden of critical illness. To describe baseline characteristics, treatment, and outcomes of consecutive critically ill patients in Mexico hospitals that treated the majority of such patients with confirmed, probable, or suspected 2009 influenza A(H1N1). Observational study of 58 critically ill patients with 2009 influenza A(H1N1) at 6 hospitals between March 24 and June 1, 2009. Demographic data, symptoms, comorbid conditions, illness progression, treatments, and clinical outcomes were collected using a piloted case report form. The primary outcome measure was mortality. Secondary outcomes included rate of 2009 influenza (A)H1N1-related critical illness and mechanical ventilation as well as intensive care unit (ICU) and hospital length of stay. Critical illness occurred in 58 of 899 patients (6.5%) admitted to the hospital with confirmed, probable, or suspected 2009 influenza (A)H1N1. Patients were young (median, 44.0 [range, 10-83] years); all presented with fever and all but 1 with respiratory symptoms. Few patients had comorbid respiratory disorders, but 21 (36%) were obese. Time from hospital to ICU admission was short (median, 1 day [interquartile range {IQR}, 0-3 days]), and all patients but 2 received mechanical ventilation for severe acute respiratory distress syndrome and refractory hypoxemia (median day 1 ratio of Pao(2) to fraction of inspired oxygen, 83 [IQR, 59-145] mm Hg). By 60 days, 24 patients had died (41.4%; 95% confidence interval, 28.9%-55.0%). Patients who died had greater initial severity of illness, worse hypoxemia, higher creatine kinase levels, higher creatinine levels, and ongoing organ dysfunction. After adjusting for a reduced opportunity of patients dying early to receive neuraminidase inhibitors, neuraminidase inhibitor treatment (vs no treatment) was associated with improved survival (odds ratio, 8.5; 95% confidence interval, 1.2-62.8). Critical illness from 2009 influenza A(H1N1) in Mexico occurred in young individuals, was associated with severe acute respiratory distress syndrome and shock, and had a high case-fatality rate.
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                Author and article information

                Contributors
                Jrello.hj23.ics@gencat.cat
                Journal
                Intensive Care Med
                Intensive Care Med
                Intensive Care Medicine
                Springer-Verlag (Berlin/Heidelberg )
                0342-4642
                1432-1238
                24 November 2010
                2011
                : 37
                : 2
                : 272-283
                Affiliations
                [1 ]Critical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona, Spain
                [2 ]GRID grid.414449.8, ISNI 0000000101253761, Critical Care Department, , Hospital de Clinicas de Porto Alegre, ; Porto Alegre, Brazil
                [3 ]GRID grid.451349.e, Critical Care Department, St. George’s Healthcare NHS Trust, ; London, UK
                [4 ]GRID grid.418334.9, ISNI 0000 0004 0625 3076, Unidade de Cuidados Intensivos Polivalente, , Hospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E., ; Lisbon, Portugal
                [5 ]GRID grid.413562.7, ISNI 0000000103851941, ICU, Hospital Israelita Albert Einstein, ; São Paulo, Brazil
                [6 ]GRID grid.17788.31, ISNI 0000000122212926, Department of Anesthesiology and Critical Care Medicine, , Hadassah Hebrew University Medical Center, ; Jerusalem, Israel
                [7 ]GRID grid.10992.33, ISNI 0000000121880914, Service de Réanimation Médicale, Hôpital Cochin (AP-HP), , Université Paris Descartes, ; Unité Inserm U567, 75014 Pris, France
                [8 ]Unidad de Cuidados Intensivos, Hospital Eugenio Espejo, Quito, Ecuador
                [9 ]Unidad de Cuidados Intensivos, Hospital de San José, Bogotá, Colombia
                [10 ]Unidad de Cuidados Intensivos, Hospital San Martín, La Plata, Buenos Aires Argentina
                [11 ]GRID grid.4868.2, ISNI 0000000121711133, Barts and The London School of Medicine and Dentistry, , Queen Mary’s University of London Royal London Hospital, ; London, UK
                [12 ]GRID grid.7080.f, Critical Care Department, Vall d’Hebron University Hospital, Institut de Recerca Vall D’Hebron, , University Autonoma Barcelona, CIBER Enfermedades Respiratorias (CIBERes), ; Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
                Article
                2078
                10.1007/s00134-010-2078-z
                7079858
                21107529
                ec361690-bf24-4daf-861d-15b8f47f0020
                © Copyright jointly held by Springer and ESICM 2010

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 25 March 2010
                : 24 August 2010
                Categories
                Original
                Custom metadata
                © Copyright jointly held by Springer and ESICM 2011

                Emergency medicine & Trauma
                community acquired pneumonia,pandemic (h1n1)v influenza a infection,corticosteroid therapy,ards

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