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Al-Yousif N, Nouraie SM, Broerman MJ, Zhang Y, Suber TL, Evankovich J, Bain WG, Kitsios GD, McVerry BJ, Shah FA. Glucocorticoid use in acute respiratory failure from pulmonary causes and association with early changes in the systemic host immune response. Intensive Care Med Exp 2024; 12:24. [PMID: 38441708 PMCID: PMC10914652 DOI: 10.1186/s40635-024-00605-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Glucocorticoids are commonly used in patients with or at-risk for acute respiratory distress syndrome (ARDS), but optimal use remains unclear despite well-conducted clinical trials. We performed a secondary analysis in patients previously enrolled in the Acute Lung Injury and Biospecimen Repository at the University of Pittsburgh. The primary aim of our study was to investigate early changes in host response biomarkers in response to real-world use of glucocorticoids in patients with acute respiratory failure due to ARDS or at-risk due to a pulmonary insult. Participants had baseline plasma samples obtained on study enrollment and on follow-up 3 to 5 days later to measure markers of innate immunity (IL-6, IL-8, IL-10, TNFr1, ST2, fractalkine), epithelial injury (sRAGE), endothelial injury (angiopoietin-2), and host response to bacterial infections (procalcitonin, pentraxin-3). In our primary analyses, we investigated the effect of receiving glucocorticoids between baseline and follow-up samples on host response biomarkers measured at follow-up by doubly robust inverse probability weighting analysis. In exploratory analyses, we examined associations between glucocorticoid use and previously characterized host response subphenotypes (hyperinflammatory and hypoinflammatory). RESULTS 67 of 148 participants (45%) received glucocorticoids between baseline and follow-up samples. Dose and type of glucocorticoids varied. Regimens that used hydrocortisone alone were most common (37%), and median daily dose was equivalent to 40 mg methylprednisolone (interquartile range: 21, 67). Participants who received glucocorticoids were more likely to be female, to be on immunosuppressive therapy at baseline, and to have higher baseline levels of ST-2, fractalkine, IL-10, pentraxin-3, sRAGE, and TNFr1. Glucocorticoid use was associated with decreases in IL-6 and increases in fractalkine. In exploratory analyses, glucocorticoid use was more frequent in participants in the hyperinflammatory subphenotype (58% vs 40%, p = 0.05), and was not associated with subphenotype classification at the follow-up time point (p = 0.16). CONCLUSIONS Glucocorticoid use varied in a cohort of patients with or at-risk for ARDS and was associated with early changes in the systemic host immune response.
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Affiliation(s)
- Nameer Al-Yousif
- Division of Pulmonary, Critical Care, and Sleep Medicine, MetroHealth Medical Center, Cleveland, OH, USA
| | - Seyed M Nouraie
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
- Acute Lung Injury and Infection Center, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
| | - Matthew J Broerman
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
| | - Yingze Zhang
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
| | - Tomeka L Suber
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
- Acute Lung Injury and Infection Center, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
| | - John Evankovich
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
- Acute Lung Injury and Infection Center, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
- Aging Institute, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
| | - William G Bain
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
- Acute Lung Injury and Infection Center, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
- Veteran's Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Georgios D Kitsios
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
- Acute Lung Injury and Infection Center, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
- Center for Medicine and the Microbiome, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
| | - Bryan J McVerry
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
- Acute Lung Injury and Infection Center, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
- Center for Medicine and the Microbiome, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA
| | - Faraaz A Shah
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA.
- Acute Lung Injury and Infection Center, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore NW 628, Pittsburgh, PA, 15213, USA.
- Veteran's Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
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