Relationship between corticosteroid use and incidence of ventilator-associated pneumonia in COVID-19 patients: a retrospective multicenter study
Authors: Saura Ouriel , Rouzé Anahita , Martin-Loeches Ignacio , Povoa Pedro , Kreitmann Louis , Torres Antoni , Metzelard Matthieu , Du Cheyron Damien , Lambiotte Fabien , Tamion Fabienne , Labruyere Marie , Boulle Geronimi Claire , Luyt Charles-Edouard , Nyunga Martine , Pouly Olivier , Thille Arnaud W. , Megarbane Bruno , Saade Anastasia , Magira Eleni , Llitjos Jean-François , Ioannidou Iliana , Pierre Alexandre , Reignier Jean , Garot Denis , Baudel Jean-Luc , Voiriot Guillaume , Plantefeve Gaëtan , Morawiec Elise , Asfar Pierre , Boyer Alexandre , Mekontso-Dessap Armand , Bardaka Fotini , Diaz Emili , Vinsonneau Christophe , Floch Pierre-Edouard , Weiss Nicolas , Ceccato Adrian , Artigas Antonio , Nora David , Duhamel Alain , Labreuche Julien , Nseir Saad ,   coVAPid Study Group, Bouchereau Mathilde , Boyd Sean , Coelho Luis , Maizel Julien , Cuchet Pierre , Zarrougui Wafa , Boyer Déborah , Quenot Jean-Pierre , Imouloudene Mehdi , Pineton de Chambrun Marc , Van der Linden Thierry , Arrive François , Voicu Sebastian , Azoulay Elie , Moglia Edgard , Pene Frédéric , Cilloniz Catia , Thevenin Didier , Larrat Charlotte , Argaud Laurent , Guidet Bertrand , Contou Damien , Beurton Alexandra , Meguerditchian David , Razazi Keyvan , Tsolaki Vassiliki , Marzouk Mehdi , Brunin Guillaume , Marois Clémence , Morales Luis 
Published: September 2022

Abstract
Background
Ventilator-associated pneumonia (VAP) is common in patients with severe SARS-CoV-2 pneumonia. The aim of this ancillary analysis of the coVAPid multicenter observational retrospective study is to assess the relationship between adjuvant corticosteroid use and the incidence of VAP.

Methods
Planned ancillary analysis of a multicenter retrospective European cohort in 36 ICUs. Adult patients receiving invasive mechanical ventilation for more than 48 h for SARS-CoV-2 pneumonia were consecutively included between February and May 2020. VAP diagnosis required strict definition with clinical, radiological and quantitative microbiological confirmation. We assessed the association of VAP with corticosteroid treatment using univariate and multivariate cause-specific Cox’s proportional hazard models with adjustment on pre-specified confounders.

Results
Among the 545 included patients, 191 (35%) received corticosteroids. The proportional hazard assumption for the effect of corticosteroids on the incidence of VAP could not be accepted, indicating that this effect varied during ICU stay. We found a non-significant lower risk of VAP for corticosteroid-treated patients during the first days in the ICU and an increased risk for longer ICU stay. By modeling the effect of corticosteroids with time-dependent coefficients, the association between corticosteroids and the incidence of VAP was not significant (overall effect p = 0.082), with time-dependent hazard ratios (95% confidence interval) of 0.47 (0.17–1.31) at day 2, 0.95 (0.63–1.42) at day 7, 1.48 (1.01–2.16) at day 14 and 1.94 (1.09–3.46) at day 21.

Conclusions
No significant association was found between adjuvant corticosteroid treatment and the incidence of VAP, although a time-varying effect of corticosteroids was identified along the 28-day follow-up.