Effect of preadmission glucocorticoid therapy on 30-day mortality in critically ill patients: a retrospective study of a mixed ICU population in a tertiary hospital

Tak Kyu Oh,Hee-Joon Bae,Jae Ho Lee,You Hwan Jo,Cheong Lim,In-Ae Song,Young-Tae Jeon

doi:10.1186/s13613-019-0489-8

Tak Kyu Oh, Hee-Joon Bae + Show 5 more

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https://doi.org/10.1186/s13613-019-0489-8

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Abstract

BackgroundThis study aimed to investigate the association between preadmission glucocorticoid (GC) therapy and 30-day mortality in critically ill patients following admission to an intensive care unit (ICU). We aimed to determine whether this association differed according to daily GC dosage and type. We conducted a retrospective cohort study of adult patients admitted to a single tertiary academic hospital ICU from January 2012 to December 2017. We classified the patients regularly undergoing oral GC therapy as preadmission GC users, and those with no history of GC use were classified as non-GC users.ResultsThe study included 24,929 patients, of whom 816 (3.3%) were preadmission GC users. Thirty-day mortality in preadmission GC users (173 of 816 patients) was 21.2% compared to 8.8% (2113 of 24,113 patients) in non-GC users. Multivariate Cox regression analysis showed that preadmission GC users had a 1.62-fold increase in 30-day mortality compared to non-GC users [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.29–2.03, P < 0.001]. When comparing preadmission GC users with diabetes mellitus to non-GC users, a 2.29-fold increase in 30-day mortality was noted (HR 2.29, 95% CI 1.08–4.86, P = 0.031). In the sensitivity analysis, compared to non-GC users, daily dosages of ≤ 5 and > 5 mg of prednisolone in preadmission GC users showed 1.45-fold (HR 1.45, 95% CI 1.03–2.03, P = 0.033) and 1.67-fold (HR 1.67, 95% CI 1.25–2.24, P = 0.001) increases, respectively, in 30-day mortality after ICU admission. Moreover, prednisolone, methylprednisolone, and dexamethasone users in the preadmission GC users group showed 1.56-fold (HR 1.56, 95% CI 1.21–2.01, P = 0.001), 1.90-fold (HR 1.90, 95% CI 1.12–3.25, P = 0.018), and 1.30-fold (HR 1.30, 95% CI 1.05–1.50, P = 0.042) increases, respectively, in 30-day mortality compared to non-GC users.ConclusionPreadmission GC use among critically ill patients was associated with an increased 30-day mortality after ICU admission compared to non-GC use. This association was more prevalent in preadmission GC users with diabetes mellitus and in preadmission GC users who took > 5 mg/day of prednisolone and methylprednisolone.

Highlights

This study aimed to investigate the association between preadmission glucocorticoid (GC) therapy and 30-day mortality in critically ill patients following admission to an intensive care unit (ICU)
One cohort study has reported that preadmission GC use increased 30-day mortality after stroke [14], and another cohort study showed a decrease in the incidence of acute respiratory distress syndrome (ARDS) in sepsis patients [15]
This association was more prevalent in preadmission GC users with diabetes mellitus and in preadmission GC users who took a higher daily dosage, such as > 5 mg/day of prednisolone

Summary

Introduction

This study aimed to investigate the association between preadmission glucocorticoid (GC) therapy and 30-day mortality in critically ill patients following admission to an intensive care unit (ICU). Chronic GC use has a direct immunosuppressive effect that leads to an increased risk of infection [10], and chronic GC use can lead to central adrenal failure [11] In this regard, chronic GC use prior to admission to an intensive care unit (ICU) could increase the mortality risk, especially in critically ill patients more susceptible to infection and mortality due to sepsis [12]. Few studies have investigated the effects of preadmission GC use in critically ill patients; this issue remains challenging

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