Obstructive Lung Diseases |

Steroid Dose and ICU Outcomes in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease FREE TO VIEW

Vijay Kodadhala, MD; O'Dene Lewis, MD; Chad Hines, MD; John Kwagyan, PhD; Alem Mehari, MD; Alicia Thomas, MD
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Howard University Hospital, Washington, DC

Chest. 2015;148(4_MeetingAbstracts):717A. doi:10.1378/chest.2278410
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Chronic obstructive lung disease (COPD) is the 3rd leading cause of mortality in the US. An acute exacerbation is associated with poor prognosis.During COPD exacerbations the optimal dosing of steroids and its effects on ICU outcomes remains debatable. The purpose of this study is to determine the effects of steroid dosing on outcomes of patients with acute exacerbation of COPD admitted to ICU.

METHODS: A retrospective chart review of patients admitted to the ICU with a primary diagnosis of acute exacerbation of COPD between January and December 2012 was done. Patients who required at least 24 hours of ICU admission were included. Demographic data, cumulative steroid dose in the ICU, need for mechanical / non-invasive ventilation (NIV), vasopressor use, ICU length of stay, mortality, baseline spirometry, and radiographic evidence of emphysema were abstracted from medical records.

RESULTS: A total of 680 patients were admitted to ICU during the study period, of which 52 had a primary diagnosis of acute exacerbation of COPD. All patients were African Americans, 27 (51.9 %) patients were males and 25 (48.9 %) were females. Mean age was 65.3±12.07 years. Patients had moderate to severe COPD with mean FEV1 of 1.27±0.71L, 47±25% of predicted. All patients received either intravenous or oral steroids (methylprednisolone in mg) or combination of both. The mean cumulative steroid dose received in the ICU was 678.04±511.65. Compared to those patients with COPD who got a cumulative steroid dose below the mean, those who got above the mean tend to be younger (61.5±11.2 vs.68.2±12.1yrs; p=0.046), had higher BMI (29.3±7.1 vs 23.8±8.3 Kg/m2;p=0.016), worse lung function (FEV1%pred 41.6± 17.9 vs 49.7%±28.6; P=0.09); lower Pa02/FiO2 ratio (220.8±75,.2 vs. 285.1±120.9; 0.027), and longer ICU stay (6.5±5.2 vs 3.2±3.4 days; p=0.010). Fifteen (28.8%) patients received NIV and 13 (25%) patients were intubated. Patients who were intubated received a higher total steroid dose in the ICU compared with patients who were not intubated (1172±689.91 vs. 513±299.45; p=0.001). There were a total of 3 (5.8%) deaths and ICU mortality was not affected by steroid dose.

CONCLUSIONS: Patients who received higher cumulative doses of steroids had longer ICU stay and had a higher need of mechanical ventilation.

CLINICAL IMPLICATIONS: Patients with premorbid conditions required higher steroid doses during exacerbations and had worse ICU outcomes. Further research with a larger sample size is needed to determine optimal steroid dosing.

DISCLOSURE: The following authors have nothing to disclose: Vijay Kodadhala, O'Dene Lewis, Chad Hines, John Kwagyan, Alem Mehari, Alicia Thomas

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