Corticosteroids for severe acute exacerbations of chronic obstructive pulmonary disease in intensive care: From the French OUTCOMEREA cohort

by Louis Marie Galerneau, Sébastien Bailly, Nicolas Terzi, Stéphane Ruckly, Maïté Garrouste-Orgeas, Yves Cohen, Vivien Hong Tuan Ha, Marc Gainnier, Shidasp Siami, Claire Dupuis, Michael Darmon, Elie Azoulay, Jean-Marie Forel, Florian Sigaud, Christophe Adrie, Dany Goldgran-Toledano, Alexis Ferré, Etienne de Montmollin, Laurent Argaud, Jean Reignier, Jean-Louis Pepin, Jean-François Timsit, on behalf of the OUTCOMEREA network

Introduction

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.

Methods

In the OutcomeRea^TM 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.

Results

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.

Conclusion

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.