Abstract
Background: High-dose steroids (HDS) are used in specialist settings for the treatment of ARDS with features suggesting steroid responsiveness or as a last resort. Our previous case-matched cohort demonstrated that HDS increase 6mo. mortality (Remmington et. al, 2019).
Aims and objectives: Identify if response to HDS predicted favourable outcomes.
Methods: A retrospective observational study from a tertiary specialist respiratory ICU identified 79 patients (5 excluded) between 2009-2017 who received HDS for ARDS (AECC/Berlin criteria). Patients were grouped according to the change in lung injury score (LIS) between days 0 and 10 following HDS initiation. A modified LIS (excluding PF ratios for patients on ECMO) was used. Changes in LIS were grouped as follows; full responders (FR) ≥ 2, partial responders (PR) ≥ 1 and < 2, and non-responders (NR) < 1.
Results: This study identified 7 (9.5%) FR, 14 (18.9%) PR, and 53 (71.6%) NR. Figure 1 shows the mortality for each group, which was significantly reduced when comparing the combined PR+FR groups to the NR group (p (log rank test) < 0.0001).
Figure 1 – mortality over time in patients with different LIS responses
Conclusions: A low proportion (28.4%) of ARDS patients given HDS had a FR or PR by day 10 yet these patients had significantly reduced mortality at 24mo. Further research using modified LIS to predict steroid responsiveness may assist clinicians in selecting ARDS patients for rescue therapy.
Footnotes
Cite this article as Eur Respir J 2022; 60: Suppl. 66, 2979.
This article was presented at the 2022 ERS International Congress, in session “-”.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2022
