Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study
Ouriel Saura, Anahita Rouzé, Ignacio Martín‐Loeches, Pedro Póvoa, Louis Kreitmann, Antoní Torres, Matthieu Metzelard, Damien du Cheyron, Fabien Lambiotte, Fabienne Tamion, Marie Labruyère, Claire Boulle Geronimi, Charles‐Édouard Luyt, Martine Nyunga, Olivier Pouly, Arnaud W. Thille, Bruno Mégarbane, Anastasia Saade, Eleni Magira, Jean‐François Llitjos, Iliana Ioannidou, Alexandre Pierre, Jean Reignier, Denis Garot, Jean-Luc Baudel, Guillaume Voiriot, Gaëtan Plantefève, Élise Morawiec, Pierre Asfar, Alexandre Boyer, Armand Mekontso Dessap, Fotini Bardaka, Emili Dı́az, Christophe Vinsonneau, Pierre-Edouard Floch, Nicolas Weiss, Adrián Ceccato, Antonio Artigas, David Nora, Alain Duhamel, Julien Labreuche, Saad Nseir, coVAPid Study Group, Mathilde Bouchereau, Seán Boyd, Luís Coelho, Julien Maizel, Pierre Cuchet, Wafa Zarrougui, Déborah Boyer, Jean‐Pierre Quenot, Mehdi Imouloudene, Marc Pineton de Chambrun, Thierry Van Der Linden, François Arrivé, Sébastian Voicu, Élie Azoulay, Edgard Moglia, Frédéric Pène, Catia Cillóniz, Didier Thévenin, Charlotte Larrat, Laurent Argaud, Bertrand Guidet, Damien Contou, Alexandra Beurton, David Meguerditchian, Keyvan Razazi, Vassiliki Tsolaki, Mehdi Marzouk, Guillaume Brunin, Clémence Marois, Luis Morales
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.