Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France.
Intensive Care Unit, Ramsay Générale de Santé - Jacques Cartier Hospital, Massy, France.
Minerva Anestesiol. 2023 Sep;89(9):783-791. doi: 10.23736/S0375-9393.23.17196-3. Epub 2023 May 11.
Immunosuppressors (IS) such as Dexamethasone (DXM), Tocilizumab, and high-dose methylprednisolone boli (HDMB), are used in COVID-19-related acute respiratory distress syndrome (ARDS). This study aimed to determine whether COVID-19 ARDS-related combined IS therapy was associated with an increased incidence of ICU-acquired pneumonia (IAP).
We retrospectively analyzed COVID-19-ARDS admitted to ICU from March 2020 to April 2022. Patients' and IAP characteristics were analyzed according to five IS regimens: No IS, DXM alone, DXM+HDMB, DXM+tocilizumab, and DXM+tocilizumab+HDMB. To investigate the role of IS on IAP incidence, we performed a multivariate logistic regression and built a propensity score. Ultimately, we used a conditional logistic regression after pairing on the propensity score.
The study included 496 COVID-19-ARDS. Regarding the IS therapy, 12.7% received no IS, 43% DXM alone, 21.6% DXM+HDMB, 15.5% DXM+tocilizumab and 5.4% DXM+tocilizumab+HDMB. 37% presented at least one IAP, and the IAP incidence was higher with DXM+HDMB (66.4%) compared to no IS (P<0.0001), DXM (P<0.0001) and DXM+tocilizumab (P<0.0001). HDMB and probabilistic antibiotherapy at admission were independent IAP predictors after adjustment on the propensity score (respectively OR:2.44; P<0.0001 and OR:2.85; P<0.001).
In critically ill COVID-19, HDMB significantly increases the risk of IAP whereas DXM alone, nor in combination with tocilizumab, did not.
地塞米松（DXM）、托珠单抗和大剂量甲基强的松龙冲击（HDMB）等免疫抑制剂（IS）用于 COVID-19 相关急性呼吸窘迫综合征（ARDS）。本研究旨在确定 COVID-19 ARDS 相关联合 IS 治疗是否与 ICU 获得性肺炎（IAP）发生率增加有关。
我们回顾性分析了 2020 年 3 月至 2022 年 4 月入住 ICU 的 COVID-19-ARDS 患者。根据五种 IS 方案（无 IS、DXM 单药、DXM+HDMB、DXM+托珠单抗和 DXM+托珠单抗+HDMB）分析患者和 IAP 特征。为了研究 IS 对 IAP 发生率的作用，我们进行了多变量逻辑回归并构建了倾向评分。最终，我们在倾向评分配对后使用条件逻辑回归。
本研究纳入了 496 例 COVID-19-ARDS 患者。在 IS 治疗方面，12.7%未接受 IS，43%接受 DXM 单药治疗，21.6%接受 DXM+HDMB 治疗，15.5%接受 DXM+托珠单抗治疗，5.4%接受 DXM+托珠单抗+HDMB 治疗。37%出现至少一次 IAP，与无 IS（P<0.0001）、DXM（P<0.0001）和 DXM+托珠单抗（P<0.0001）相比，DXM+HDMB 组的 IAP 发生率更高。在校正倾向评分后，HDMB 和入院时的经验性抗生素治疗是 IAP 的独立预测因素（OR：2.44；P<0.0001 和 OR：2.85；P<0.001）。
在重症 COVID-19 患者中，HDMB 显著增加 IAP 的风险，而 DXM 单药治疗或与托珠单抗联合使用则不会。
