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Lee, Lee, Kim, Cho, Jeong, Kim, Lee, Kim, and Hwang: Systemic Corticosteroid Treatment in Severe Community-Acquired Pneumonia Requiring Mechanical Ventilation: Impact on Outcomes and Complications
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2012; 72(2): 149-155.

Published online: 29 February 2012

DOI: https://doi.org/10.4046/trd.2012.72.2.149

Systemic Corticosteroid Treatment in Severe Community-Acquired Pneumonia Requiring Mechanical Ventilation: Impact on Outcomes and Complications

Seung Jun Lee, M.D.1, Seung Hun Lee, M.D.1, You Eun Kim, M.D.1, Yu Ji Cho, M.D.1, 2, Yi Yeong Jeong, M.D.1, 2, Ho Cheol Kim, M.D.1, 2, Jong Deog Lee, M.D.1, 2, Jang Rak Kim, M.D.2, 3, Young Sil Hwang, M.D.1, 2

1Department of Internal Medicine, Gyeongsang National University College of Medicine, Jinju, Korea.

2Gyeongsang Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea.

3Department of Preventive Medicine, Gyeongsang National University College of Medicine, Jinju, Korea.

Address for correspondence: Ho Cheol Kim, M.D. Department of Internal Medicine, Gyeongsang National University College of Medicine, 90, Chiram-dong, Jinju 660-302, Korea. Phone: 82-55-750-8684, Fax: 82-55-750-8618, hochkim@gnu.ac.kr

Received 7 September 2011       Revised 10 October 2011       Accepted 22 December 2011

Copyright © 2012. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Background

This study is to evaluate the effect of systemic corticosteroid on the clinical outcomes and the occurrence of complications in mechanical ventilated patients with severe community-acquired pneumonia (CAP).

Methods

We retrospectively assessed the clinical outcomes and complications in patients with severe CAP admitted to ICU between March 1, 2003 and July 28, 2009. Outcomes were measured by hospital mortality after ICU admission, duration of mechanical ventilation (MV), ICU, and hospital stay. Complications such as ventilator associated pneumonia (VAP), catheter related-blood stream infection (CR-BSI), and upper gastrointestinal (UGI) bleeding during ICU stay were assessed.

Results

Of the 93 patients, 36 patients received corticosteroids over 7 days while 57 patients did not receive corticosteroids. Age, underlying disease, APACHE II, PSI score, and use of vasopressor were not different between two groups. In-hospital mortality was 30.5% in the steroid group and 36.8% in the non-steroid group (p>0.05). The major complications such as VAP, CR-BSI and UGI bleeding was significantly higher in the steroid group than in the non-steroid group (19.4% vs. 7%, p<0.05). The use of steroids and the duration of ICU stay were significantly associated with the development of major complications during ones ICU stay (p<0.05).

Conclusion

Systemic corticosteroid in patients with severe CAP requiring mechanical ventilation may have no beneficial effect on clinical outcomes like duration of ICU stay and in-hospital mortality but may contribute to the development of ICU acquired complications.

Keywords: Pneumonia, Community-Acquired, Adrenal Cortex Hormones, Respiration, Artificial, Mortality, complications

Figures and Tables

Table 1
Baseline characteristics of the study population
trd-72-149-i001

Values are presented mean±SD and number (%). Data was calculated with t-test and chi-sqaure test.

APACHE: acute physiology and chronic health evaluation; PSI: pneumonia severity index; BP: blood pressure; SD: standard deviation.

Table 2
The patients' outcomes
trd-72-149-i002

Values are presented mean±SD unless otherwise indicated. Data was calculated with t-test and chi-square test.

MV: mechanical ventilation; ICU: intensive care unit; SD: standard deviation.

Table 3
The development of complications in the ICU
trd-72-149-i003

Values are presented as number (%). Data was calculated with chi-square test.

ICU: intensive care unit.

Table 4
Factors associated with increased hospital mortality by using multivariate analysis
trd-72-149-i004

Data was calculated with multivariate logistic regression analysis.

OR: odds ratio; CI: confidence interval; APACHE: acute physiology and chronic health evaluation; PSI: pneumonia severity index; ICU: intensive care unit.

Table 5
Factors associated with the development of major complications in ICU stay by using multivariate analysis
trd-72-149-i005

Data was calculated with multivariate logistic regression analysis.

OR: odds ratio; CI: confidence interval; APACHE: acute physiology and chronic health evaluation; PSI: pneumonia severity index; ICU: intensive care unit; MV: mechanical ventilation.

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