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

• Published in: Critical care (London, England) Vol. 26; no. 1; pp. 1 - 292
• Main Authors: Saura, Ouriel, Rouzé, Anahita, Martin-Loeches, Ignacio, Povoa, Pedro, Kreitmann, Louis, Torres, Antoni, Metzelard, Matthieu, Du Cheyron, Damien, Lambiotte, Fabien, Tamion, Fabienne, Labruyere, Marie, Boulle Geronimi, Claire, Luyt, Charles-Edouard, Nyunga, Martine, Pouly, Olivier, Thille, Arnaud W., Megarbane, Bruno, Saade, Anastasia, Magira, Eleni, Llitjos, Jean-François, Ioannidou, Iliana, Pierre, Alexandre, Reignier, Jean, Garot, Denis, Baudel, Jean-Luc, Voiriot, Guillaume, Plantefeve, Gaëtan, Morawiec, Elise, Asfar, Pierre, Boyer, Alexandre, Mekontso-Dessap, Armand, Bardaka, Fotini, Diaz, Emili, Vinsonneau, Christophe, Floch, Pierre-Edouard, Weiss, Nicolas, Ceccato, Adrian, Artigas, Antonio, Nora, David, Duhamel, Alain, Labreuche, Julien, Nseir, Saad, Bouchereau, Mathilde, Boyd, Sean, Coelho, Luis, Maizel, Julien, Cuchet, Pierre, Zarrougui, Wafa, Boyer, Déborah, Quenot, Jean-Pierre, Imouloudene, Mehdi, Pineton de Chambrun, Marc, Van der Linden, Thierry, Arrive, François, Voicu, Sebastian, Azoulay, Elie, Moglia, Edgard, Pene, Frédéric, Cilloniz, Catia, Thevenin, Didier, Larrat, Charlotte, Argaud, Laurent, Guidet, Bertrand, Contou, Damien, Beurton, Alexandra, Meguerditchian, David, Razazi, Keyvan, Tsolaki, Vassiliki, Marzouk, Mehdi, Brunin, Guillaume, Marois, Clémence, Morales, Luis
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 27-09-2022; BioMed Central; BMC
• Subjects: Complications and side effects; Coronaviruses; Corticosteroids; COVID-19; Critical care; Life Sciences; Mortality; Risk factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Ventilator-associated lower respiratory tract infections; Ventilator-associated pneumonia; Ventilators; Europe
• ISSN: 1364-8535; 1364-8535; 1366-609X; 1466-609X
• DOI: 10.1186/s13054-022-04170-2

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.