Survival curves at day 90 according to corticosteroids therapy for AECOPD at admission in ICU (n = 863).

Effects of corticosteroids in survival analysis (cox model) for 90-day survival: HR = 0.79 [0.6; 1.06], p = 0.121. (DOCX)</p

Ventilatory support used for patients admitted in ICU for a severe AECOPD.

ICU: Intensive Care Unit. NIV: Non-Invasive Ventilation. IMV: Invasive Mechanical Ventilation. (DOCX)</p

Double Robust Analysis of the association between prescription of corticosteroids at admission in ICU for AECOPD and in-hospital death.

Adjustment also performed on centre and year. Survival analysis performed with a cox model. ICU: Intensive Care Unit. AECOPD: Acute exacerbation of chronic obstructive pulmonary disease. COPD: Chronic Obstructive Pulmonary Disease. BMI: Body Mass Index. SOFA: Sequential Organ Failure Assessment. Pa02: Partial pressure of oxygen. FiO2: Fraction of inspired oxygen. NIV: Non-Invasive Ventilation. IMV: Invasive Mechanical Ventilation. (DOCX)</p

Survival curves at day 28 according to corticosteroids therapy for AECOPD at admission in ICU (n = 863).

Not very Severe COPD patients or unknown COPD severity. Effects of corticosteroids in survival analysis (cox model) for 28-day survival for patients with not very severe COPD or unknown COPD Severity: HR = 0.85 [0.58; 1.26], p = 0.420. COPD: Chronic obstructive pulmonary disease. (DOCX)</p

Summary of results for corticosteroids therapy and ventilator-free days.

All patients and sub-groups of patients. VFD at day 28 is express in Median and interquartiles of days, Median [Q1; Q3]. IRR: Incidence Rate Ratio. VFD: Ventilator-free days. IMV: Invasive Mechanical Ventilation. NIV: Non-Invasive Ventilation. (DOCX)</p

OutcomeRea^TM database.

IntroductionAcute exacerbation of chronic obstructive pulmonary disease (COPD) is a frequent cause of intensive care unit (ICU) admission. However, data are scarce and conflicting regarding the impact of systemic corticosteroid treatment in critically ill patients with acute exacerbation of COPD. The aim of the study was to assess the impact of systemic corticosteroids on the occurrence of death or need for continuous invasive mechanical ventilation at day 28 after ICU admission.MethodsIn the OutcomeReaTM prospective French national ICU database, we assessed the impact of corticosteroids at admission (daily dose ≥ 0.5 mg/kg of prednisone or equivalent during the first 24 hours ICU stay) on a composite outcome (death or invasive mechanical ventilation) using an inverse probability treatment weighting.ResultsBetween January 1, 1997 and December 31, 2018, 391 out of 1,247 patients with acute exacerbations of COPDs received corticosteroids at ICU admission. Corticosteroids improved the main composite endpoint (OR = 0.70 [0.49; 0.99], p = 0.044. However, for the subgroup of most severe COPD patients, this did not occur (OR = 1.12 [0.53; 2.36], p = 0. 770). There was no significant impact of corticosteroids on rates of non-invasive ventilation failure, length of ICU or hospital stay, mortality or on the duration of mechanical ventilation. Patients on corticosteroids had the same prevalence of nosocomial infections as those without corticosteroids, but more glycaemic disorders.ConclusionUsing systemic corticosteroids for acute exacerbation of COPD at ICU admission had a positive effect on a composite outcome defined by death or need for invasive mechanical ventilation at day 28.</div

Statistical analysis.

Decrease in the prescription of corticosteroid therapy over the years. (DOCX)</p

Summary of results for corticosteroids therapy regarding the endpoint “Alive and antibiotic-free days” at 5 days, 10 days and 15 days.

AFD is express in Median and interquartiles of days, Median [Q1; Q3]. IRR: Incidence Rate Ratio. AFD: Antibiotic-free days. LOS: Length of stay. (DOCX)</p

Side effects definitions.

IntroductionAcute exacerbation of chronic obstructive pulmonary disease (COPD) is a frequent cause of intensive care unit (ICU) admission. However, data are scarce and conflicting regarding the impact of systemic corticosteroid treatment in critically ill patients with acute exacerbation of COPD. The aim of the study was to assess the impact of systemic corticosteroids on the occurrence of death or need for continuous invasive mechanical ventilation at day 28 after ICU admission.MethodsIn the OutcomeReaTM prospective French national ICU database, we assessed the impact of corticosteroids at admission (daily dose ≥ 0.5 mg/kg of prednisone or equivalent during the first 24 hours ICU stay) on a composite outcome (death or invasive mechanical ventilation) using an inverse probability treatment weighting.ResultsBetween January 1, 1997 and December 31, 2018, 391 out of 1,247 patients with acute exacerbations of COPDs received corticosteroids at ICU admission. Corticosteroids improved the main composite endpoint (OR = 0.70 [0.49; 0.99], p = 0.044. However, for the subgroup of most severe COPD patients, this did not occur (OR = 1.12 [0.53; 2.36], p = 0. 770). There was no significant impact of corticosteroids on rates of non-invasive ventilation failure, length of ICU or hospital stay, mortality or on the duration of mechanical ventilation. Patients on corticosteroids had the same prevalence of nosocomial infections as those without corticosteroids, but more glycaemic disorders.ConclusionUsing systemic corticosteroids for acute exacerbation of COPD at ICU admission had a positive effect on a composite outcome defined by death or need for invasive mechanical ventilation at day 28.</div

Baseline characteristics of the population at admission to ICUs for severe AECOPD.

Baseline characteristics of the population at admission to ICUs for severe AECOPD.</p