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Comparative Study
. 2006 Feb;141(2):145-9; discussion 149.
doi: 10.1001/archsurg.141.2.145.

Corticosteroid use in the intensive care unit: at what cost?

Rebecca C Britt1, Alicia Devine, Karen C Swallen, Leonard J Weireter, Jay N Collins, Frederic J Cole, L D Britt
Affiliations
Comparative Study

Corticosteroid use in the intensive care unit: at what cost?

Rebecca C Brittet al. Arch Surg. 2006 Feb.

Abstract

Hypothesis:Corticosteroid use has a significant effect on morbidity and mortality in the intensive care unit (ICU).

Design:Case-control study.

Setting:Burn-trauma ICU in a level 1 trauma center.

Patients:All patients who received corticosteroids while in the ICU from January 1, 2002, to December 31, 2003 (n = 100), matched by age and Injury Severity Score with a control group (n = 100).

Interventions:None.

Main outcome measures:We considered the following 7 outcomes: pneumonia, bloodstream infection, urinary tract infection, other infections, ICU length of stay (LOS), ventilator LOS, and mortality.

Results:Cases and controls had similar APACHE II (Acute Physiology and Chronic Health Evaluation II) scores and medical history. In univariate analysis, the corticosteroid group had a significant increase in pneumonia (26% vs 12%; P<.01), bloodstream infection (19% vs 7%; P<.01), and urinary tract infection (17% vs 8%; P<.05). In multivariate models, corticosteroid use was associated with an increased rate of pneumonia (odds ratio [OR], 2.64; 95% confidence interval [CI], 1.21-5.75) and bloodstream infection (OR, 3.25; 95% CI, 1.26-8.37). There was a trend toward increased urinary tract infection (OR, 2.31; 95% CI, 0.94-5.69), other infections (OR, 2.57; 95% CI, 0.87-7.67), and mortality (OR, 1.89; 95% CI, 0.81-4.40). Patients in the ICU who received corticosteroids had a longer ICU LOS by 7 days (P<.01) and longer ventilator LOS by 5 days (P<.01).

Conclusions:Corticosteroid use is associated with increased rate of infection, increased ICU and ventilator LOS, and a trend toward increased mortality. Caution must be taken to carefully consider the indications, risks, and benefits of corticosteroids when deciding on their use.

Comment in

  • Steroids and the intensive care unit.
    Marx WH. Marx WH. Arch Surg. 2006 Sep;141(9):945-6; author reply 947. doi: 10.1001/archsurg.141.9.945-b. Arch Surg. 2006. PMID:16983040 No abstract available.
  • Corticosteroids in critically ill patients: A long and winding road.
    Salluh JI, Fuks AG. Salluh JI, et al. Arch Surg. 2006 Sep;141(9):945; author reply 947. doi: 10.1001/archsurg.141.9.945-a. Arch Surg. 2006. PMID:16983041 No abstract available.
  • Using corticosteroids in intensive care.
    Marik PE, Annane D, Sprung CL, Arlt W, Keh D; International Task Force on the Diagnoses and Management of adrenal Insufficiency in the Critically Ill. Marik PE, et al. Arch Surg. 2006 Sep;141(9):946-7; author reply 947. doi: 10.1001/archsurg.141.9.946. Arch Surg. 2006. PMID:16983042 No abstract available.

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