Medical Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France.
HP2 laboratory, Grenoble Alpes University, INSERM U1300, Grenoble, France.
PLoS One. 2023 Apr 19;18(4):e0284591. doi: 10.1371/journal.pone.0284591. eCollection 2023.
Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a frequent cause of intensive care unit (ICU) admission. However, data are scarce and conflicting regarding the impact of systemic corticosteroid treatment in critically ill patients with acute exacerbation of COPD. The aim of the study was to assess the impact of systemic corticosteroids on the occurrence of death or need for continuous invasive mechanical ventilation at day 28 after ICU admission.
In the OutcomeReaTM prospective French national ICU database, we assessed the impact of corticosteroids at admission (daily dose ≥ 0.5 mg/kg of prednisone or equivalent during the first 24 hours ICU stay) on a composite outcome (death or invasive mechanical ventilation) using an inverse probability treatment weighting.
Between January 1, 1997 and December 31, 2018, 391 out of 1,247 patients with acute exacerbations of COPDs received corticosteroids at ICU admission. Corticosteroids improved the main composite endpoint (OR = 0.70 [0.49; 0.99], p = 0.044. However, for the subgroup of most severe COPD patients, this did not occur (OR = 1.12 [0.53; 2.36], p = 0. 770). There was no significant impact of corticosteroids on rates of non-invasive ventilation failure, length of ICU or hospital stay, mortality or on the duration of mechanical ventilation. Patients on corticosteroids had the same prevalence of nosocomial infections as those without corticosteroids, but more glycaemic disorders.
Using systemic corticosteroids for acute exacerbation of COPD at ICU admission had a positive effect on a composite outcome defined by death or need for invasive mechanical ventilation at day 28.
慢性阻塞性肺疾病（COPD）急性加重是重症监护病房（ICU）收治的常见原因。然而，关于皮质类固醇系统治疗对急性加重期 COPD 危重症患者的影响的数据仍然有限且存在争议。本研究旨在评估 ICU 入住后第 28 天皮质类固醇治疗对死亡或持续有创机械通气需求的影响。
在 OutcomeReaTM 前瞻性法国全国 ICU 数据库中，我们评估了皮质类固醇入院时（入住 ICU 的前 24 小时内，每日剂量≥0.5mg/kg 泼尼松或等效剂量）对复合结局（死亡或有创机械通气）的影响，使用逆概率治疗加权法。
1997 年 1 月 1 日至 2018 年 12 月 31 日，1247 例急性加重期 COPD 患者中有 391 例在 ICU 入住时接受了皮质类固醇治疗。皮质类固醇治疗改善了主要复合终点（OR=0.70 [0.49；0.99]，p=0.044）。然而，对于最严重的 COPD 患者亚组，这并未发生（OR=1.12 [0.53；2.36]，p=0.770）。皮质类固醇治疗对无创通气失败率、ICU 或住院时间、死亡率或机械通气持续时间没有显著影响。接受皮质类固醇治疗的患者与未接受皮质类固醇治疗的患者的院内感染发生率相同，但血糖紊乱的发生率更高。
在 ICU 入住时对急性加重期 COPD 使用全身性皮质类固醇治疗，对第 28 天死亡或需要有创机械通气的复合结局有积极影响。
