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

Ouriel Saura; Anahita Rouzé; Ignacio Martin-Loeches; Pedro Povoa; Louis Kreitmann; Antoni Torres; Matthieu Metzelard; Damien Du Cheyron; Fabien Lambiotte; Fabienne Tamion; Marie Labruyere; Claire Boulle Geronimi; Charles Edouard Luyt; Martine Nyunga; Olivier Pouly; Arnaud W. Thille; Bruno Megarbane; Anastasia Saade; Eleni Magira; Jean François Llitjos; Iliana Ioannidou; Alexandre Pierre; Jean Reignier; Denis Garot; Jean Luc Baudel; Guillaume Voiriot; Gaëtan Plantefeve; Elise Morawiec; Pierre Asfar; Alexandre Boyer; Armand Mekontso-Dessap; Fotini Bardaka; Emili Diaz; Christophe Vinsonneau; Pierre Edouard Floch; Nicolas Weiss; Adrian Ceccato; Antonio Artigas; David Nora; Alain Duhamel; Julien Labreuche; Saad Nseir; coVAPid Study Group

doi:10.1186/s13054-022-04170-2

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

Ouriel Saura, Anahita Rouzé, Ignacio Martin-Loeches, Pedro Povoa, Louis Kreitmann, Antoni Torres, Matthieu Metzelard, Damien Du Cheyron, Fabien Lambiotte, Fabienne Tamion, Marie Labruyere, Claire Boulle Geronimi, Charles Edouard Luyt, Martine Nyunga, Olivier Pouly, Arnaud W. Thille, Bruno Megarbane, Anastasia Saade, Eleni Magira, Jean François LlitjosIliana Ioannidou, Alexandre Pierre, Jean Reignier, Denis Garot, Jean Luc Baudel, Guillaume Voiriot, Gaëtan Plantefeve, Elise Morawiec, Pierre Asfar, Alexandre Boyer, Armand Mekontso-Dessap, Fotini Bardaka, Emili Diaz, Christophe Vinsonneau, Pierre Edouard Floch, Nicolas Weiss, Adrian Ceccato, Antonio Artigas, David Nora, Alain Duhamel, Julien Labreuche, Saad Nseir^*, coVAPid Study Group

^*Kontaktforfatter

KI, OUH, Forskningsenhed for Klinisk Epidemiologi (Odense)

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

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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.

Originalsprog	Engelsk
Artikelnummer	292
Tidsskrift	Critical Care
Vol/bind	26
Antal sider	11
ISSN	1364-8535
DOI	https://doi.org/10.1186/s13054-022-04170-2
Status	Udgivet - 27. sep. 2022

Bibliografisk note

Funding Information:
Mathilde Bouchereau (CHU de Lille, Centre de Réanimation, F-59000 Lille, France), Sean Boyd (Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St.’James's Hospital, Dublin, Ireland), Luis Coelho (Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal and NOVA Medical School, CHRC, New University of Lisbon, Portugal), Julien Maizel (Service de médecine intensive réanimation, CHU Amiens Picardie, 80000 Amiens, France), Pierre Cuchet (Department of Medical Intensive Care, Caen University Hospital, F-14000 Caen, France), Wafa Zarrougui (Service de réanimation polyvalente, Centre hospitalier de Valenciennes, Valenciennes, France), Déborah Boyer (Medical Intensive Care Unit, Rouen University Hospital, 76000 Rouen, France), Jean-Pierre Quenot (Department of Intensive Care, François Mitterrand University Hospital, Dijon, France), Mehdi Imouloudene (Service de réanimation et de soins intensifs, Centre hospitalier de Douai, France), Marc Pineton de Chambrun (Service de Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris Cedex 13, France), Thierry Van der Linden (Service de médecine intensive réanimation, Hôpital Saint Philibert GHICL, université catholique, Lille, France), François Arrive (CHU de Poitiers, Médecine Intensive Réanimation, CIC 1402 ALIVE France université de Poitiers, Poitiers, France), Sebastian Voicu (Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris University, Paris, France), Elie Azoulay (Service de médecine intensive réanimation, Hôpital Saint-Louis, 75010 Paris, France), Edgard Moglia (Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain), Frédéric Pene (Medical Intensive Care Unit, Cochin Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France), Catia Cilloniz (Department of Pulmonology, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain), Didier Thevenin (Service de réanimation polyvalente, Centre Hospitalier de Lens, Lens, France), Charlotte Larrat (Service de Médecine Intensive Réanimation CHU de Tours, Hôpital Bretonneau, 37044 Tours Cedex 9, France), Laurent Argaud (Service de Médecine Intensive - Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69437 Lyon Cedex 03, France), Bertrand Guidet (Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France), Damien Contou (Service de réanimation polyvalente, CH Victor Dupouy, Argenteuil, France), Alexandra Beurton (Service de Médecine Intensive-Réanimation et Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, France), David Meguerditchian (Service de médecine intensive réanimation, CHU de Bordeaux, F-33000 Bordeaux, France), Keyvan Razazi (Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation; Université Paris Est Créteil, CARMAS; INSERM U955, Institut Mondor de recherche Biomédicale; F-94010 Créteil, France), Vassiliki Tsolaki (Intensive Care Unit, University Hospital of Larissa, University of Thessaly, Biopolis Larissa, 41110 Greece), Mehdi Marzouk (Intensive Care Unit, Hôpital de Béthune, 62408 Béthune, France), Guillaume Brunin (Service de réanimation, Hôpital Duchenne, 62200 Boulogne-sur-Mer, France), Clémence Marois (Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hôpital de la Pitié-Salpêtrière, Département de Neurologie, Unité de Médecine Intensive Réanimation Neurologique, Paris, France), Luis Morales (Intensive Care Unit, Hospital Unive rsitari Sagrat Cor, Barcelona, Spain)

Funding Information:
This study was supported in part by a grant from the French government through the « Programme Investissement d’Avenir» (I-SITE ULNE) managed by the Agence Nationale de la Recherche (coVAPid project). Prof. Ignacio Martin-Loeches has been supported by SFI (Science Foundation Ireland), Grant number 20/COV/0038. The funders of the study had no role in the study design, data collection, analysis or interpretation, writing of the report or decision to submit for publication.

Funding Information:
AR received personal fees from Maat Pharma, and IML received personal fees from MSD and Gilead. AA received personal fees from Lilly Foundation and grants from Grifols and Fisher & Paykel. CEL received personal fees from Bayer, Merck, Aerogen, bioMérieux, ThermoFisher Brahms and Carmat. SN received personal fees from MSD, Bio Rad, bioMérieux, Gilead, Fisher & Paykel and Pfizer. All other authors declare no competing interests.

Dokumenter og links

10.1186/s13054-022-04170-2Licens: CC BY

Open Access VersionForlagets udgivne version, 1,09 MBLicens: CC BY

Citationsformater

Saura, O., Rouzé, A., Martin-Loeches, I., Povoa, P., Kreitmann, L., Torres, A., Metzelard, M., Du Cheyron, D., Lambiotte, F., Tamion, F., Labruyere, M., Boulle Geronimi, C., Luyt, C. E., Nyunga, M., Pouly, O., Thille, A. W., Megarbane, B., Saade, A., Magira, E., ... coVAPid Study Group (2022). Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study. Critical Care, 26, Artikel 292. https://doi.org/10.1186/s13054-022-04170-2

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

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{\textquoteright}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.",

keywords = "Corticosteroids, COVID-19, SARS-CoV-2, Ventilator-associated lower respiratory tract infections, Pneumonia, Ventilator-Associated/drug therapy, Intensive Care Units, COVID-19/complications, Humans, Adult, Respiration, Artificial/adverse effects, Retrospective Studies, Incidence",

author = "Ouriel Saura and Anahita Rouz{\'e} and Ignacio Martin-Loeches and Pedro Povoa and Louis Kreitmann and Antoni Torres and Matthieu Metzelard and {Du Cheyron}, Damien and Fabien Lambiotte and Fabienne Tamion and Marie Labruyere and {Boulle Geronimi}, Claire and Luyt, {Charles Edouard} and Martine Nyunga and Olivier Pouly and Thille, {Arnaud W.} and Bruno Megarbane and Anastasia Saade and Eleni Magira and Llitjos, {Jean Fran{\c c}ois} and Iliana Ioannidou and Alexandre Pierre and Jean Reignier and Denis Garot and Baudel, {Jean Luc} and Guillaume Voiriot and Ga{\"e}tan Plantefeve and Elise Morawiec and Pierre Asfar and Alexandre Boyer and Armand Mekontso-Dessap and Fotini Bardaka and Emili Diaz and Christophe Vinsonneau and Floch, {Pierre Edouard} and Nicolas Weiss and Adrian Ceccato and Antonio Artigas and David Nora and Alain Duhamel and Julien Labreuche and Saad Nseir and {coVAPid Study Group}",

note = "Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = sep,

day = "27",

doi = "10.1186/s13054-022-04170-2",

language = "English",

volume = "26",

journal = "Critical Care",

issn = "1364-8535",

publisher = "BioMed Central",

}

Saura, O, Rouzé, A, Martin-Loeches, I, Povoa, P, Kreitmann, L, Torres, A, Metzelard, M, Du Cheyron, D, Lambiotte, F, Tamion, F, Labruyere, M, Boulle Geronimi, C, Luyt, CE, Nyunga, M, Pouly, O, Thille, AW, Megarbane, B, Saade, A, Magira, E, Llitjos, JF, Ioannidou, I, Pierre, A, Reignier, J, Garot, D, Baudel, JL, Voiriot, G, Plantefeve, G, Morawiec, E, Asfar, P, Boyer, A, Mekontso-Dessap, A, Bardaka, F, Diaz, E, Vinsonneau, C, Floch, PE, Weiss, N, Ceccato, A, Artigas, A, Nora, D, Duhamel, A, Labreuche, J, Nseir, S & coVAPid Study Group 2022, 'Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study', Critical Care, bind 26, 292. https://doi.org/10.1186/s13054-022-04170-2

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 - Diaz, Emili

AU - Vinsonneau, Christophe

AU - Floch, Pierre Edouard

AU - Weiss, Nicolas

AU - Ceccato, Adrian

AU - Artigas, Antonio

AU - Nora, David

AU - Duhamel, Alain

AU - Labreuche, Julien

AU - Nseir, Saad

AU - coVAPid Study Group

PY - 2022/9/27

Y1 - 2022/9/27

N2 - 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.

AB - 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.

KW - Corticosteroids

KW - COVID-19

KW - SARS-CoV-2

KW - Ventilator-associated lower respiratory tract infections

KW - Pneumonia, Ventilator-Associated/drug therapy

KW - Intensive Care Units

KW - COVID-19/complications

KW - Humans

KW - Adult

KW - Respiration, Artificial/adverse effects

KW - Retrospective Studies

KW - Incidence

U2 - 10.1186/s13054-022-04170-2

DO - 10.1186/s13054-022-04170-2

M3 - Journal article

C2 - 36167550

AN - SCOPUS:85138959991

SN - 1364-8535

VL - 26

JO - Critical Care

JF - Critical Care

M1 - 292

ER -

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

Abstract

Bibliografisk note

Dokumenter og links

Fingeraftryk

Citationsformater