Division of Pulmonary and Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA.
Crit Care Med. 2013 Jul;41(7):1679-85. doi: 10.1097/CCM.0b013e31828a1fc7.
The role of systemic corticosteroids in pathophysiology and treatment of acute respiratory distress syndrome is controversial. Use of prehospital systemic corticosteroid therapy may prevent the development of acute respiratory distress syndrome and improve hospital outcomes.
This is a preplanned retrospective subgroup analysis of the prospectively identified cohort from a trial by the U.S. Critical Illness and Injury Trials Group designed to validate the Lung Injury Prediction Score.
Twenty-two acute care hospitals.
: Five thousand eighty-nine patients with at least one risk factor for acute respiratory distress syndrome at the time of hospitalization.
Propensity-based analysis of previously recorded data.
Three hundred sixty-four patients were on systemic corticosteroids. Prevalence of acute respiratory distress syndrome was 7.7% and 6.9% (odds ratio, 1.1 [95% CI, 0.8-1.7]; p = 0.54) for patients on systemic corticosteroid and not on systemic corticosteroids, respectively. A propensity for being on systemic corticosteroids was derived through logistic regression by using all available covariates. Subsequently, 354 patients (97%) on systemic corticosteroids were matched to 1,093 not on systemic corticosteroids by their propensity score for a total of 1,447 patients in the matched set. Adjusted risk for acute respiratory distress syndrome (odds ratio, 0.96 [95% CI, 0.54-1.38]), invasive ventilation (odds ratio, 0.84 [95% CI, 0.62-1.12]), and in-hospital mortality (odds ratio, 0.97 [95% CI, 0.63-1.49]) was then calculated from the propensity-matched sample using conditional logistic regression model. No significant associations were present.
Prehospital use of systemic corticosteroids neither decreased the development of acute respiratory distress syndrome among patients hospitalized with at one least risk factor, nor affected the need for mechanical ventilation or hospital mortality.
全身性皮质类固醇在急性呼吸窘迫综合征的病理生理学和治疗中的作用存在争议。使用院前全身性皮质类固醇治疗可能会预防急性呼吸窘迫综合征的发展并改善住院结果。
这是对美国危重病和伤害试验组前瞻性确定的队列中前瞻性识别的队列的预先计划的回顾性亚组分析，旨在验证肺损伤预测评分。
22 家急性护理医院。
至少有一个急性呼吸窘迫综合征风险因素的 5089 名住院患者。
基于倾向的数据分析。
有 364 名患者接受了全身性皮质类固醇治疗。全身性皮质类固醇组和未用全身性皮质类固醇组的急性呼吸窘迫综合征发生率分别为 7.7%和 6.9%（比值比，1.1 [95%CI，0.8-1.7]；p=0.54）。通过使用所有可用协变量进行逻辑回归得出使用全身性皮质类固醇的倾向。随后，通过倾向评分将 354 名（97%）使用全身性皮质类固醇的患者与 1093 名未使用全身性皮质类固醇的患者进行匹配，共纳入 1447 名匹配患者。使用条件逻辑回归模型从倾向匹配样本中计算出急性呼吸窘迫综合征（比值比，0.96 [95%CI，0.54-1.38]）、有创通气（比值比，0.84 [95%CI，0.62-1.12]）和院内死亡率（比值比，0.97 [95%CI，0.63-1.49]）的调整风险，均无显著相关性。
在至少有一个风险因素住院的患者中，院前使用全身性皮质类固醇既不能降低急性呼吸窘迫综合征的发生，也不能影响机械通气的需要或医院死亡率。
