PURPOSE: Early recognition of patients at risk for development of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) may offer opportunities for preventative interventions. Inhaled corticosteroids (ICS) were previously shown to protect against ALI in animal models. We postulate that pre-hospital use of ICS has a protective effect on ALI/ARDS development among patients at increased risk.
METHODS: This is a secondary analysis of the Lung Injury Prediction Score (LIPS) multi-center cohort, where 5584 patients admitted to 22 acute care hospitals with at least one risk factor for ALI/ARDS were prospectively enrolled. Patients receiving systemic corticosteroids (SC) were excluded. The association between pre-hospital use of ICS and development of ALI/ARDS was determined after adjusting for important covariates. The patients were grouped based on the underlying risk for developing ALI/ARDS by either direct or indirect mechanisms.
RESULTS: Out of 5584 patients, 221 were excluded as they were receiving SC. At the time of the admission, 1513 patients had risk factors for direct and remaining patients for indirect lung injury. In univariate analyses, inhaled steroids were significantly associated with decreased risk for ALI/ARDS among all patients (p=0.05) and particularly so among patients at risk for direct (p<0.007) but not among the patients with risks for indirect ALI/ARDS. Majority of patients on ICS received concomitant inhaled beta agonists (78%). When adjusted for age, race, gender, obstructive lung disease (COPD and asthma), medications (aspirin and statins), and LIPS in a predefined stratified logistic regression analysis, pre-hospital use of ICS was associated with decreased risk of ALI/ARDS by direct injury mechanism (adjusted OR 0.39, 95% CI 0.14-0.93, p=0.049).
CONCLUSIONS: Pre-hospital use of ICS was associated with decreased risk of ALI/ARDS by direct mechanisms. This association may have been confounded by concomitant use of inhaled beta agonists in majority of patients exposed to ICS.
CLINICAL IMPLICATIONS: A prospective, randomized, placebo-controlled study of prophylactic ICS administration to high-risk patients for direct ALI/ARDS is warranted.
DISCLOSURE: The following authors have nothing to disclose: Enrique Ortiz-Diaz, Guangxi Li, Daryl Kor, Ognjen Gajic, Ozan Akca, Adebola Adesanya, Jason Hoth, Emir Festic
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