Abstract
Background: Acute respiratory distress syndrome (ARDS) is a common cause of respiratory failure in patients in intensive care unit (ICU). The therapeutic value of glucocorticoids (GCs) in the prognosis of ARDS remains controversial. The aim of this research is studying the impacts of GCs treatment on ARDS patients in ICU.Methods: We retrospectively studied 2,167 ARDS patients whose data were collected from the public eICU Collaborative Research Database, among which 254 patients who received glucocorticoid (GCs) treatment were 1:1 matched by propensity matching analysis (PSM). The primary outcome was ICU mortality. Every oxygenation index (PaO2/FiO2) measurement before death or ICU discharge was recorded. A joint model (JM) which combined longitudinal sub-model (mixed-effect model) and time-to-event sub-model (Cox regression model) by trajectory functions of PaO2/FiO2 was conducted to determine the effects of GCs treatment on both ICU mortality and PaO2/FiO2 level and further PaO2/FiO2's effect on event status. The marginal structural cox model (MSCM) adjusted the overall PaO2/FiO2 of patients to further validate the results.Results: The result of the survival sub-model showed that GCs treatment was significantly associated with reduced ICU mortality in ARDS patients [HR (95% CI) = 0.642 (0.453, 0.912)], demonstrating that GCs treatment was a protective factor of ICU mortality. In the longitudinal sub-model, GCs treatment was not correlated to the PaO2/FiO2. After adjusted by the JM, the HR of GCs treatment was 0.602 while GCs was still not significantly related to PaO2/FiO2 level. The JM-induced association showed that higher PaO2/FiO2 was a significant protective factor of mortality in ARDS patients and the HR was 0.991 which demonstrated that one level increase of PaO2/FiO2 level decreased 0.9% risk of ICU mortality. MSCM results also show that GCs can improve the prognosis of patients.Conclusion: Rational use of GCs can reduce the ICU mortality of ARDS patients in ICU. In addition to the use of GCs treatment, clinicians should also focus on the shifting trend of PaO2/FiO2 level to provide better conditions for patients' survival.
Highlights
Acute respiratory distress syndrome (ARDS) has a high incidence and is one of the most common severe diseases in intensive care unit (ICU) [1, 2], which is a manifestation of lung parenchymal disease and represents various serious conditions, ranging from transient dyspnea to rapid respiratory failure [3]
The data analyzed in this study were extracted from the eICU Collaborative Research Database, which is a public multicenter intensive care unit (ICU) database containing data on over 200,000 patients [17, 18]
The results indicated that after the adjustment, GCs treatment was still a protective factor for ARDS patients (HR = 0.602), indicating that patients who received GCs treatments had 39.8% lower risk of mortality
Summary
Acute respiratory distress syndrome (ARDS) has a high incidence and is one of the most common severe diseases in intensive care unit (ICU) [1, 2], which is a manifestation of lung parenchymal disease and represents various serious conditions, ranging from transient dyspnea to rapid respiratory failure [3]. A randomized trial by Tomazini et al showed that the use of intravenous dexamethasone can increase the survival days of patients with COVID-19 and moderate or severe ARDS [12]. Another randomized study showed that dexamethasone reduced 28-day mortality in COVID-19 patients on mechanical ventilation [13]. There are still many studies that have shown no beneficial effects of GCs use in patients with severe pulmonary infection or ARDS [14]. Acute respiratory distress syndrome (ARDS) is a common cause of respiratory failure in patients in intensive care unit (ICU).
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