Do Steroids Benefit Influenza Pneumonia?

Written by Clay Smith

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Unless there was a compelling alternative reason to do so (i.e. asthma), giving a glucocorticoid to treat influenza pneumonia was associated with an increased risk of mortality.

Why does this matter?
Steroids benefit patients with community acquired pneumonia, according to this Cochrane review and IDSA meta-analysis.  But does this hold true for patients with influenza pneumonia?

Flumonia is not the same
This was a secondary analysis of prospectively collected data from 148 ICUs in Spain and included patients with confirmed influenza pneumonia.  Patients who received corticosteroids for another indication, such as asthma, COPD, or refractory shock were excluded.  In total, 1846 were included, of which 604 (32.7%) received steroids.  Most often, methylprednisolone at an 80mg median dose for 7 days was given.  Unadjusted mortality was higher in those who received steroids: 27.5% vs. 18.8%, p < 0.001.  Mortality was also higher in the steroid recipients for almost all subgroups.  Using propensity score analysis to create matched groups from this observational data, increased mortality risk remained.  There was a 32% increase in the hazard of ICU mortality for those who received steroids for influenza pneumonia with propensity score matching.

Source
Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study.  Intensive Care Med. 2018 Aug 3. doi: 10.1007/s00134-018-5332-4. [Epub ahead of print]
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Reviewed by Thomas Davis

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