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Article Dans Une Revue PLoS ONE Année : 2023

Corticosteroids for severe acute exacerbations of chronic obstructive pulmonary disease in intensive care: From the French OUTCOMEREA cohort

Louis Marie Galerneau
Nicolas Terzi
  • Fonction : Auteur
Stéphane Ruckly
  • Fonction : Auteur
Maïté Garrouste-Orgeas
Yves Cohen
  • Fonction : Auteur
Vivien Hong Tuan Ha
Marc Gainnier
Shidasp Siami
  • Fonction : Auteur
Claire Dupuis
Michael Darmon
  • Fonction : Auteur
Elie Azoulay
  • Fonction : Auteur
Jean-Marie Forel
  • Fonction : Auteur
Florian Sigaud
  • Fonction : Auteur
Christophe Adrie
  • Fonction : Auteur
Dany Goldgran-Toledano
  • Fonction : Auteur
Alexis Ferré
  • Fonction : Auteur
Laurent Argaud
  • Fonction : Auteur
Jean Reignier
  • Fonction : Auteur

Résumé

Introduction Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a frequent cause of intensive care unit (ICU) admission. However, data are scarce and conflicting regarding the impact of systemic corticosteroid treatment in critically ill patients with acute exacerbation of COPD. The aim of the study was to assess the impact of systemic corticosteroids on the occurrence of death or need for continuous invasive mechanical ventilation at day 28 after ICU admission. Methods In the OutcomeRea TM prospective French national ICU database, we assessed the impact of corticosteroids at admission (daily dose ≥ 0.5 mg/kg of prednisone or equivalent during the first 24 hours ICU stay) on a composite outcome (death or invasive mechanical ventilation) using an inverse probability treatment weighting. Results Between January 1, 1997 and December 31, 2018, 391 out of 1,247 patients with acute exacerbations of COPDs received corticosteroids at ICU admission. Corticosteroids improved the main composite endpoint (OR = 0.70 [0.49; 0.99], p = 0.044. However, for the subgroup of most severe COPD patients, this did not occur (OR = 1.12 [0.53; 2.36], p = 0. 770). There was no significant impact of corticosteroids on rates of non-invasive ventilation failure, length of ICU or hospital stay, mortality or on the duration of mechanical ventilation. Patients on corticosteroids had the same prevalence of nosocomial infections as those without corticosteroids, but more glycaemic disorders. Conclusion Using systemic corticosteroids for acute exacerbation of COPD at ICU admission had a positive effect on a composite outcome defined by death or need for invasive mechanical ventilation at day 28.
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hal-04090452 , version 1 (01-02-2024)

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Louis Marie Galerneau, Sébastien Bailly, Nicolas Terzi, Stéphane Ruckly, Maïté Garrouste-Orgeas, et al.. Corticosteroids for severe acute exacerbations of chronic obstructive pulmonary disease in intensive care: From the French OUTCOMEREA cohort. PLoS ONE, 2023, 18 (4), pp.e0284591. ⟨10.1371/journal.pone.0284591⟩. ⟨hal-04090452⟩
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