Corticosteroid Therapy for Critically Ill Patients with Middle East Respiratory Syndrome

被引:787
作者
Arabi, Yaseen M. [1 ]
Mandourah, Yasser [4 ,5 ,6 ]
Al-Hameed, Fahad [7 ]
Sindi, Anees A. [8 ]
Almekhlafi, Ghaleb A. [6 ]
Hussein, Mohamed A. [2 ]
Jose, Jesna [2 ]
Pinto, Ruxandra [9 ]
Al-Omari, Awad [10 ,11 ]
Kharaba, Ayman [12 ,13 ]
Almotairi, Abdullah [14 ]
Al Khatib, Kasim [15 ]
Alraddadi, Basem [10 ,16 ]
Shalhoub, Sarah [17 ]
Abdulmomen, Ahmed [18 ]
Qushmaq, Ismael [16 ]
Mady, Ahmed [19 ,20 ]
Solaiman, Othman [21 ]
Al-Aithan, Abdulsalam M. [22 ]
Al-Raddadi, Rajaa [23 ]
Ragab, Ahmed [24 ]
Balkhy, Hanan H. [1 ,5 ]
Al Harthy, Abdulrahman [19 ]
Deeb, Ahmad M. [3 ]
Al Mutairi, Hanan [3 ]
Al-Dawood, Abdulaziz [1 ,4 ,5 ]
Merson, Laura [25 ]
Hayden, Frederick G. [25 ,26 ]
Fowler, Robert A. [27 ,28 ,29 ]
机构
[1] King Saud Bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Coll Med, Riyadh, Saudi Arabia
[2] King Saud Bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Dept Biostat & Bioinformat, Riyadh, Saudi Arabia
[3] King Saud Bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Res Off, Riyadh, Saudi Arabia
[4] Natl Guard Hlth Affairs, King Abdulaziz Med City, Intens Care Dept, Riyadh, Saudi Arabia
[5] Natl Guard Hlth Affairs, King Abdulaziz Med City, Dept Infect Prevent & Control, Riyadh, Saudi Arabia
[6] Prince Sultan Mil Med City, Dept Intens Care Serv, Riyadh, Saudi Arabia
[7] King Saud Bin Abdulaziz Univ Hlth Sci, King Abdulaziz Med City, King Abdullah Int Med Res Ctr, Dept Intens Care, Jeddah, Saudi Arabia
[8] King Abdulaziz Univ, Fac Med, Dept Anesthesia & Crit Care, Jeddah, Saudi Arabia
[9] Sunnybrook Med Ctr, Univ Toronto, Toronto, ON, Canada
[10] Alfaisal Univ, Coll Med, Riyadh, Saudi Arabia
[11] Dr Sulaiman Al Habib Grp Hosp, Dept Intens Care, Riyadh, Saudi Arabia
[12] King Fahad Hosp, Dept Crit Care, Al Madinah Al Monawarah, Saudi Arabia
[13] Ohoud Hosp, Dept Crit Care, Al Madinah Al Monawarah, Saudi Arabia
[14] King Fahad Med City, Dept Crit Care Med, Riyadh, Saudi Arabia
[15] Al Noor Specialist Hosp, Intens Care Dept, Mecca, Saudi Arabia
[16] King Faisal Specialist Hosp & Res Ctr, Dept Med, Jeddah, Saudi Arabia
[17] King Fahad Armed Forces Hosp, Div Infect Dis, Dept Med, Jeddah, Saudi Arabia
[18] King Saud Univ, Dept Crit Care Med, Riyadh, Saudi Arabia
[19] Tanta Univ Hosp, Dept Anesthesiol & Intens Care, Tanta, Egypt
[20] King Saud Med City, Intens Care Dept, Riyadh, Saudi Arabia
[21] King Faisal Specialist Hosp & Res Ctr, Riyadh, Saudi Arabia
[22] King Abdulaziz Hosp, Intens Care Dept, Al Hasa, Saudi Arabia
[23] Minist Hlth, Dept Res, Jeddah, Saudi Arabia
[24] King Fahad Cent Hosp, Intens Care Dept, Jeddah, Saudi Arabia
[25] Univ Oxford, Int Severe Acute Resp & Emerging Infect Consortiu, Infect Dis Data Observ, Oxford, England
[26] Univ Virginia, Sch Med, Dept Med, Div Infect Dis & Int Hlth, Charlottesville, VA 22908 USA
[27] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada
[28] Sunnybrook Med Ctr, Dept Crit Care Med, Toronto, ON, Canada
[29] Sunnybrook Med Ctr, Dept Med, Toronto, ON, Canada
关键词
respiratory distress syndrome; coronavirus; pneumonia; Saudi Arabia; corticosteroid; COMMUNITY-ACQUIRED PNEUMONIA; MARGINAL STRUCTURAL MODELS; IMMORTAL TIME BIAS; CRITICAL-CARE; SARS; MULTICENTER; SURVIVAL;
D O I
10.1164/rccm.201706-1172OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Rationale: Corticosteroid therapy is commonly used among critically ill patients with Middle East Respiratory Syndrome (MERS), but its impact on outcomes is uncertain. Analyses of observational studies often do not account for patients' clinical condition at the time of corticosteroid therapy initiation. Objectives: To investigate the association of corticosteroid therapy on mortality and on MERS coronavirus RNA clearance in critically ill patients with MERS. Methods: ICU patients with MERs were included from 14 Saudi Arabian centers between September 2012 and October 2015. We performed marginal structural modeling to account for baseline and time-varying confounders. Measurements and Main Results: Of 309 patients, 151 received corticosteroids. Corticosteroids were initiated at a median of 3.0 days (quartile 1 [Q1]-Q3, 1.0-7.0) from ICU admission. Patients who received corticosteroids were more likely to receive invasive ventilation (141 of 151 [93.4%] vs. 121 of 158 [76.6%]; P < 0.0001) and had higher 90-day crude mortality (112 of 151 [74.2%] vs. 91 of 158 [57.6%]; P = 0.002). Using marginal structural modeling, corticosteroid therapy was not significantly associated with 90-day mortality (adjusted odds ratio, 0.75; 95% confidence interval, 0.52-1.07; P = 0.12) but was associated with delay in MERS coronavirus RNA clearance (adjusted hazard ratio, 0.35; 95% CI, 0.17-0.72; P = 0.005). Conclusions: Corticosteroid therapy in patients with MERS was not associated with a difference in mortality after adjustment for time varying confounders but was associated with delayed MERS coronavirus RNA clearance. These findings highlight the challenges and importance of adjusting for baseline and time-varying confounders when estimating clinical effects of treatments using observational studies.
引用
收藏
页码:757 / 767
页数:11
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