Abstract
Background: The efficacy of corticosteroid use in ARDS remains controversial. Generally, short-term high-dose corticosteroid therapy is considered to be ineffective in ARDS. On the other hand, low-dose, long-term use of corticosteroids has been reported to be effective since they provide continued inhibition of the systemic inflammatory response syndrome (SIRS) that accompanies ARDS.
Methods: We conducted a prospective observational study involving 190 cases treated at a teaching hospital (90% had infections). ARDS was diagnosed according to the Berlin definition. Cases were divided into a high-dose (n=21) or low-dose corticosteroid group (n=169) to compare the effectiveness of a down-titration regimen. The primary medical team chose which treatment a patient would receive. We were careful to conduct a differential diagnosis of interstitial pneumonia since corticosteroid treatment has been proven effective in that patient population. Primary outcome was the 60-day mortality rate.
Results: Those started on a high-dose regimen had a significantly higher 60-day mortality rate (66.7% vs 42.0%, P = 0.028) with significantly fewer ventilation-free days (VFD) (4.57 ± 8.52 vs 9.34 ± 9.37, P = 0.024). Propensity scores were used to match patient backgrounds in a variable analysis that also showed the high-dose regimen was a factor in worsening 60-day mortality rate (OR, 3.403; 95% CI, 1.025 -11.299; P = 0.045).
Conclusions: Initiating treatment with high-dose corticosteroids and a tapering regimen is likely to worsen the prognosis of patients with ARDS due to infections that meet the Berlin definition.
- Copyright ©the authors 2016
