Association of corticosteroid or paralytic use with mortality in patients with H1N1, non-H1N1/ COVID-19, and COVID-19 acute respiratory distress syndrome: A nationwide cohort study

초록

Background and Aims: The impact of corticosteroids and paralytics on outcomes of acute respiratory distress syndrome (ARDS) is controversial. We aimed to assess whether corticosteroid or paralytic use is disproportionately associated with mortality among patients with H1N1, non-H1N1/COVID-19, and COVID-19 ARDS. Methods: The Korean National Health Insurance Service database was utilized to construct (1) H1N1 cohort (May 2009–Apr 2010), (2) ARDS cohort (Jan 2015–Apr 2019), and (3) COVID-19 cohort (Jan 2020–Dec 2020). We only analyzed patients who received mechanical ventilation. Adjusted odds ratios were used to compare the risks of mortality between three cohorts. Results: Among 18,840 patients (mean [SD] age, 67.3 [14.8] years; males, 63%), 3461 (18.4%), 7596 (40.3%), and 7783 (41.3%) were diagnosed with H1N1, non-H1N1/COVID-19, and COVID-19 ARDS, respectively. Corticosteroids were used in 67% and paralytics in 21% of patients. 30-day mortality was 29.4% for H1N1 ARDS, 42.7% for non-H1N1/COVID-19 ARDS, and 28.0% for COVID-19 ARDS (p<0.001). In non-H1N1/COVID-19 ARDS, multivariate analyses revealed that corticosteroid or paralytic use was associated with both decreased 30-day and 180-day mortality. In H1N1 and COVID-19 ARDS, however, corticosteroid use was associated with decreased 30-day mortality but not with decreased 180-day mortality. Moreover, corticosteroid use with higher doses or longer duration was associated with increased 180-day mortality in COVID-19 ARDS. Paralytic use was associated with both decreased 30-day and 180-day mortality for COVID-19 ARDS but only with decreased 30-day mortality for H1N1 ARDS. Conclusion: We observed variation in association between corticosteroid use and mortality among patents with ARDS due to different etiologies. Acknowledgements: This research was supported by the research grant from Biomedical Research Institute, Chung-Ang University Hospital (2020).