Early Corticosteroids in Severe Influenza A/H1N1 Pneumonia and Acute Respiratory Distress Syndrome
Early Corticosteroids in Severe Influenza A/H1N1 Pneumonia and Acute Respiratory Distress Syndrome
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DOI：
10.1164/rccm.201101-0135oc
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发表时间：
2011-05-01
影响因子：
24.7
通讯作者：
Brochard, Laurent
中科院分区：
文献类型：
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作者：
Brun-Buisson, Christian;Richard, Jean-Christophe M.;Brochard, Laurent
基本原理：尽管其作用存在争议，但皮质类固醇经常用于继发于病毒性肺炎的成人呼吸窘迫综合征（ARDS）患者。目的：分析皮质类固醇治疗对甲型流感/H1N1肺炎相关ARDS患者预后的影响。方法：如果符合ARDS标准，则选择来自2009年甲型H1N1v流感病毒感染危重患者法国登记研究的患者，不包括有其他皮质类固醇适应症或失代偿性基础疾病作为重症监护室入院的主要原因的患者。使用考克斯回归分析出院的生存，占类固醇给药的时间，并调整后的倾向接受类固醇therapy.Measurements和主要结果：208例ARDS患者，83（39.9%）接受皮质类固醇（平均初始剂量为270毫克相当于氢化可的松，每天中位数为11天）。类固醇治疗与死亡有关，（33.7 vs. 16.8%;风险比，2.4; 95% CI，1.3 - 4.3; P = 0.004）和倾向评分调整分析后（校正的风险比，2.82; 95% CI，1.5 - 5.4; P = 0.002），控制入院严重程度简化急性生理学评分，第3版，大于50，血管加压剂的初始给药和免疫抑制。早期治疗（
Rationale: Despite their controversial role, corticosteroids are often administered to patients with adult respiratory distress syndrome (ARDS) secondary to viral pneumonia.Objectives: To analyze the impact of corticosteroid therapy on outcomes of patients having ARDS associated with influenza A/H1N1 pneumonia.Methods: Patients from the French registry of critically ill patients with influenza A/H1N1v 2009 infection were selected if fulfilling criteria for ARDS, excluding patients having other indication for corticosteroids, or decompensated underlying disease as the primary cause for intensive care unit admission. Survival to hospital discharge was analyzed using Cox regression, accounting for the time to administration of steroids, and after adjustment on the propensity for receiving steroid therapy.Measurements and Main Results: Of 208 patients with ARDS, 83 (39.9%) received corticosteroids (median initial dose of 270 mg equivalent hydrocortisone per day for a median of 11 d). Steroid therapy was associated with death, both in crude analysis (33.7 vs. 16.8%; hazard ratio, 2.4; 95% CI, 1.3-4.3; P = 0.004) and after propensity score-adjusted analysis (adjusted hazard ratio, 2.82; 95% CI, 1.5-5.4; P = 0.002), controlling for an admission severity Simplified Acute Physiology Score, version 3, greater than 50, initial administration of vasopressors, and immunodepression. Early therapy (