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Original Article
February 1, 2006

Corticosteroid Use in the Intensive Care Unit: At What Cost?

Author Affiliations

Author Affiliations: Departments of Surgery (Drs R. C. Britt, Weireter, Collins, Cole, and L. D. Britt) and Emergency Medicine (Dr Devine), Eastern Virginia Medical School, Norfolk; and Center for Demography and Ecology, University of Wisconsin, Madison (Dr Swallen).

Arch Surg. 2006;141(2):145-149. doi:10.1001/archsurg.141.2.145

Hypothesis  Corticosteroid use has a significant effect on morbidity and mortality in the intensive care unit (ICU).

Design  Case-control study.

Setting  Burn-trauma ICU in a level 1 trauma center.

Patients  All patients who received corticosteroids while in the ICU from January 1, 2002, to December 31, 2003 (n = 100), matched by age and Injury Severity Score with a control group (n = 100).

Interventions  None.

Main Outcome Measures  We considered the following 7 outcomes: pneumonia, bloodstream infection, urinary tract infection, other infections, ICU length of stay (LOS), ventilator LOS, and mortality.

Results  Cases and controls had similar APACHE II (Acute Physiology and Chronic Health Evaluation II) scores and medical history. In univariate analysis, the corticosteroid group had a significant increase in pneumonia (26% vs 12%; P<.01), bloodstream infection (19% vs 7%; P<.01), and urinary tract infection (17% vs 8%; P<.05). In multivariate models, corticosteroid use was associated with an increased rate of pneumonia (odds ratio [OR], 2.64; 95% confidence interval [CI], 1.21-5.75) and bloodstream infection (OR, 3.25; 95% CI, 1.26-8.37). There was a trend toward increased urinary tract infection (OR, 2.31; 95% CI, 0.94-5.69), other infections (OR, 2.57; 95% CI, 0.87-7.67), and mortality (OR, 1.89; 95% CI, 0.81-4.40). Patients in the ICU who received corticosteroids had a longer ICU LOS by 7 days (P<.01) and longer ventilator LOS by 5 days (P<.01).

Conclusions  Corticosteroid use is associated with increased rate of infection, increased ICU and ventilator LOS, and a trend toward increased mortality. Caution must be taken to carefully consider the indications, risks, and benefits of corticosteroids when deciding on their use.