LARGE RETROSPECTIVE STUDY ANALYZING ROLE OF STEROIDS USE IN INTUBATED PATIENTS WITH ANGIOEDEMA

Abstract

SESSION TITLE: Allergy and Airway Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Glucocorticoids are routinely given as treatment for angioedema yet the benefit is unclear and there is insufficient evidence of its role in angioedema management. In this study, we compared patients who did or did not receive corticosteroids for different angioedema subgroups. METHODS: We performed a cohort retrospective analysis of a total of 3290 angioedema patients (1241 intubated) across 185 US hospitals from period 01/2016-01/2020. Diagnosis codes were used to identify angioedema cases and time of intubation was calculated from mechanical ventilation procedure codes. Descriptive analyses of patient’s characteristics i.e. age, sex, frequencies of types of angioedema, duration of intubation, steroids administration, ICU hours, and the total length of stay were conducted. RESULTS: A total n=3,290 angioedema patients, n=205 in allergic angioedema, n=1,955 in unspecified angioedema, and n=1,151 in ACE Inhibitor angioedema were included in the study. ICU hours: Steroids did not affect ICU hours in any subgroup however, age was found to be a significant factor (P=0.001). Assuming all other variables remain constant, we found that for every additional year, a patient with any angioedema would be in the ICU for 0.51 hours longer. Total length of stay: steroids did not have a significant effect on the total length of stay in any subgroup. Length of intubation: steroids were not found to have a significant effect on the length of intubation in any subgroup. Steroids, Age, and sex relationship with the type of angioedema: there were no statistical differences in the rates of steroid use among three subgroups. A total of 61% of allergic angioedema, 63% unspecified angioedema, 63% ACE inhibitors induced angioedema and all combined 62.61% of patients received steroids. There is an association between intubation time and angioedema type (P=0.02). In the ACE Inhibitor subgroup, 58% of patients were not intubated, 9% were intubated for <24 hours, 25% were intubated for 24-96 hours, and 5% were intubated for >96 consecutive hours. In the allergic subgroup, 68% of patients were not intubated, 10% were intubated for <24 hours, 19% were intubated for 24-96 hours, and 3% were intubated for >96 consecutive hours. In the unspecified subgroup, 64% of patients were not intubated, 9.16% were intubated for <24 hours, 22% were intubated for 24-96 hours, and 5% were intubated for >96 consecutive hours. CONCLUSIONS: Steroids administration has no effect on ICU hours, length of intubation, and the total length of stay across all subgroups of angioedema. CLINICAL IMPLICATIONS: To our knowledge, this is the largest observational study conducted on intubated angioedema patients. It shows that steroids were given in 2/3 of intubated angioedema patients without any meaningful outcomes. Steroids use can potentially complicate the clinical picture and expose vulnerable patient populations to side effects. DISCLOSURES: No relevant relationships by Napatkamon Ayutyanont, source=Web Response No relevant relationships by Asma Jamil, source=Web Response No relevant relationships by Scott Kubomoto, source=Web Response No relevant relationships by Chandra Patel, source=Web Response No relevant relationships by Abu Tahir Taha, source=Web Response No relevant relationships by Sarah Wilson, source=Web Response