Effect of corticosteroid therapy in the early phase of acute respiratory distress syndrome: a propensity-matched cohort study

Abstract

Background/Aims: It is unclear whether corticosteroid use in patients with acute respiratory distress syndrome (ARDS) improves survival. This study aimed to investigate whether the administration of corticosteroids to patients in the early phase of moderate to severe ARDS is associated with improved outcomes. Methods: We analyzed the data of patients who received corticosteroids within 7 days of the onset of ARDS between June 2006 and December 2015 at a single tertiary teaching hospital. A total of 565 patients admitted with moderate to severe ARDS were eligible. The outcomes of patients treated with methylprednisolone 40 to 180 mg/day or equivalent (n = 404) were compared to those who did not receive steroids (n = 161). The primary and secondary outcomes were 28-and 90-day mortality rates, respectively. Propensity scores were used to adjust for baseline covariates. Results: The overall mortality at 28 days was not significantly different between the corticosteroid-treated and control groups (43.8% vs. 41%, p = 0.541). At 90 days, the overall mortality rate was higher in the corticosteroid-treated group than in the control group (59.2% vs. 48.4%, p = 0.021). However, on propensity score matching, corticosteroid therapy was not associated with a higher 28-day mortality rate (odds ratio, 1.031; 95% confidence interval, 0.657 to 1.618; p = 0.895) and 90 days (odds ratio, 1.435; 95% confidence interval, 0.877 to 2.348; p = 0.151). Conclusions: Corticosteroid therapy was not associated with 28-or 90-day mortality in the early phase of moderate to severe ARDS on propensity score matching analysis.

Corticosteroids in acute respiratory distress syndrome: outcomes obscured by mortality

“…In the randomized controlled trial by Tongyoo et al [6], administration of corticosteroids was not associated with 28-day mortality (22.5% vs. 27.3%, relative risk, 0.82; 95% CI, 0.50 to 1.34; p = 0.51), in line with the findings of Baek et al [9]. By contrast, a recent randomized controlled trial by Villar et al [7] showed that treatment with corticosteroids was associated with decreased mortality at day 60 (21% vs. 36%; between group difference, −15.3%; 95% CI, −25.9 to −4.9; p = 0.0047).…”

“…In an article published in The Korean Journal of Internal Medicine, Baek et al [9] report the results of a propensitymatched cohort study that investigated the effect of corticosteroids administered in the early phase of ARDS. In that study, the use of corticosteroids was not associated with 28 days (odds ratio [OR], 1.031; 95% confidence interval [CI], 0.657 to 1.618; p = 0.895) and 90 days (OR, 1.435; 95% CI, 0.877 to 2.348; p = 0.151) mortality rates after adjusting propensity scores.…”

Clinical Characteristics and Outcome of Pneumomediastinum in Patients with COVID-19 Pneumonia

“…It is not known if there may be a multifactorial increase in susceptibility to barotrauma related to inflammation as suggested by Wali et al 7 Baek et al found a correlation between PTX and steroid use in ARDS patients, but this relationship may be due to confounders such as longer duration of ventilation. 15 Other studies have not found this relationship. 16 Larger studies are needed to determine if a relationship exists between steroid administration and barotrauma in COVID-19 patients.…”

Critical Care Management for Novel 2019 SARS-CoV-2 and HCoV-NL63 Coinfection in a Young Immunocompromised Patient: A Chicago Experience

“…One confusing area has been the use of corticosteroids, which are beneficial in critically ill patients, but their use has been debated in SARS-CoV-2. In our case, the patient was previously on prednisone for tubulointerstitial nephritis, and therapy was continued mostly to avoid adrenal insufficiency [22][23][24].…”