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

Lee, Seung Jun; Lee, Seung Hun; Kim, You Eun; Cho, Yu Ji; Jeong, Yi Yeong; Kim, Ho Cheol; Lee, Jong Deog; Kim, Jang Rak; Hwang, Young Sil

doi:2012.72.2.149

Tuberc Respir Dis > Volume 72(2); 2012 > Article

Original Article

Tuberculosis and Respiratory Diseases 2012;72(2):149-155.
DOI: https://doi.org/10.4046/trd.2012.72.2.149 Published online February 1, 2012.

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

Seung Jun Lee, Seung Hun Lee, You Eun Kim, Yu Ji Cho, Yi Yeong Jeong, Ho Cheol Kim, Jong Deog Lee, Jang Rak Kim, Young Sil Hwang

¹Department of Internal Medicine, Gyeongsang National University College of Medicine, Jinju, Korea. hochkim@gnu.ac.kr
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.

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.

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