Corticosteroids Can be Dangerous in Severe Influenza Pneumonia

By Brenda L. Mooney /alert Contributor
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Primary influenza pneumonia can have a high mortality rate during pandemics, affecting not only immunocompromised patients and those with underlying comorbid conditions but also  young healthy adults, public health officials have warned.

A new study now has raised an alarm about the use of corticosteroids to treat severe influenza pneumonia in the intensive care unit.

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The report in Intensive Care Medicine noted that corticosteroid use in patients with severe influenza pneumonia is associated with increased ICU mortality and cautioned against use of those agents as co-adjuvant therapy.

While antiviral therapy is considered standard care for patients with influenza pneumonia, intravenous corticosteroids often are used with acute respiratory failure or acute respiratory distress syndrome.

The international GETGAG Study Group sought to determine clinical predictors associated with corticosteroid administration and its association with ICU mortality in critically ill patients with severe influenza pneumonia.

To do that, researchers conducted a secondary analysis of a prospective cohort study of critically ill patients with confirmed influenza pneumonia admitted to 148 ICUs in Spain between June 2009 and April 2014. Excluded were any patients who received corticosteroid treatment for causes other than viral pneumonia, such as refractory septic shock and asthma or chronic obstructive pulmonary disease (COPD) exacerbation.

Ultimately, 1,846 patients with primary influenza were enrolled, with corticosteroids – primarily methylprednisolone – administered in 32.7% of them. The median daily dose was equivalent to 80 mg of methylprednisolone (IQR 60-120) for a median duration of 7 days (IQR 5-10).

Patients treated with corticosteroid therapy were compared with those who had not received the treatment. The study team, which used a propensity score (PS) matching analysis to reduce confounding factors, defined the primary outcome as ICU mortality.

Results indicated that asthma, COPD and hematological disease, as well as the need for mechanical ventilation, were all independently associated with corticosteroid use. In addition, researchers reported that crude ICU mortality was higher in patients who received corticosteroids (27.5%) than in patients who did not receive corticosteroids (18.8%, P < .001).

After PS matching, they pointed out that corticosteroid use was associated with ICU mortality in the Cox (HR = 1.32 [95% CI 1.08-1.60], P < 0.006) and competing risks analysis (SHR = 1.37 [95% CI 1.12-1.68], P = .001).

“Administration of corticosteroids in patients with severe influenza pneumonia is associated with increased ICU mortality, and these agents should not be used as co-adjuvant therapy,” study authors advised.