Effects of systemic steroid in patients with severe community-acquired pneumonia requiring mechanical ventilation

Introduction

The effects of systemic steroids in patients with severe community-acquired pneumonia (CAP) requiring mechanical ventilation in a medical ICU (MICU) remain vague about mortality [1–4]. The aim was to evaluate systemic steroids improving survival in patients with severe CAP requiring mechanical ventilation in the MICU in this study.

Methods

A retrospective, observational study in 88 patients with severe CAP requiring mechanical ventilation in the MICU of the Asan Medical Center, Ulsan University, Seoul, South Korea. We collected information about clinical and laboratory data, and 28-day and 3-month survival from electronic medical records.

Results

From January 2005 to November 2006 we included 88 patients with severe CAP requiring mechanical ventilation in the MICU. Clinical baseline characteristics, APACHE II score and Sequential Organ Failure Assessment score were similar between the steroid group and the nonsteroid group. Steroids were highly used in acute respiratory distress syndrome (21/23), and shock (57/75) of severe CAP complication, respectively. Using multivariate analysis, longer hospital stay (OR = 1.162; 95% CI = 1.055 to 1.279), shorter ICU stay (0.824; 0.719 to 0.944), and improving Sequential Organ Failure Assessment score difference from day 1 to day 7 (1.447; 1.103 to 1.898) were associated with an increased 3-month survival. But systemic steroids did not improve 28-day and 3-month survival.

Conclusion

The effects of systemic steroids in patients with severe CAP requiring mechanical ventilation in the MICU did not improve survival.