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Research Article
No Harmful Effects of Steroids in Severe Exacerbations of COPD Associated With Influenza
Werner Albrich
Kantonsspital St. Gallen
Corresponding Author
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Background: COPD has large impact on patient morbidity and mortality worldwide. Acute exacerbations (AECOPD) are mostly triggered by respiratory infections including influenza. While corticosteroids are strongly recommended in AECOPD, they are potentially harmful during influenza. We aimed to evaluate if steroid treatment for AECOPD due to influenza may worsen outcomes.
Methods: A retrospective analysis of a Swiss nationwide hospitalisation database was conducted identifying all AECOPD hospitalisations between 2012 and 2017. In separate analyses, outcomes concerning length-of-stay (LOS), in-hospital mortality, rehospitalisation rate, admission to intensive care unit (ICU), empyema and aspergillosis were compared between AECOPD during and outside influenza season; AECOPD with and without laboratory confirmed influenza; and AECOPD plus pneumonia with and without laboratory confirmed influenza.
Results: Patients hospitalised for AECOPD during influenza season showed shorter LOS and fewer ICU admissions but higher rehospitalisation rates compared to those hospitalised outside influenza season. Patients with confirmed influenza infection had lower in-hospital mortality and rehospitalisation rates but higher risk for ICU admission than those without confirmed influenza. In patients with AECOPD plus pneumonia, there was a higher risk of ICU admission for those with laboratory-confirmed influenza compared to those without.
Conclusions: Using different indicators for influenza as the likely cause of AECOPD, we found no consistent evidence of worse outcomes of AECOPD due to influenza. Assuming that most of these patients received corticosteroids, as it is accepted standard of care throughout Switzerland, this study provides important information and supports the current practice of using corticosteroids for AECOPD independent of the influenza status.
Keywords
COPD, influenza, AECOPD, corticosteroids
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CURRENT STATUS: Under Review
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This preprint is under consideration at BMC Infectious Diseases. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
No Harmful Effects of Steroids in Severe Exacerbations of COPD Associated With Influenza
Werner Albrich
Kantonsspital St. Gallen
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 04 Jan, 2021
No community comments so far
Reviewers invited
Invitations sent on 06 Jan, 2021
Editor assigned
On 06 Jan, 2021
Editor invited
On 31 Dec, 2020
Submission checks complete
On 31 Dec, 2020
First submitted
On 19 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: COPD has large impact on patient morbidity and mortality worldwide. Acute exacerbations (AECOPD) are mostly triggered by respiratory infections including influenza. While corticosteroids are strongly recommended in AECOPD, they are potentially harmful during influenza. We aimed to evaluate if steroid treatment for AECOPD due to influenza may worsen outcomes.
Methods: A retrospective analysis of a Swiss nationwide hospitalisation database was conducted identifying all AECOPD hospitalisations between 2012 and 2017. In separate analyses, outcomes concerning length-of-stay (LOS), in-hospital mortality, rehospitalisation rate, admission to intensive care unit (ICU), empyema and aspergillosis were compared between AECOPD during and outside influenza season; AECOPD with and without laboratory confirmed influenza; and AECOPD plus pneumonia with and without laboratory confirmed influenza.
Results: Patients hospitalised for AECOPD during influenza season showed shorter LOS and fewer ICU admissions but higher rehospitalisation rates compared to those hospitalised outside influenza season. Patients with confirmed influenza infection had lower in-hospital mortality and rehospitalisation rates but higher risk for ICU admission than those without confirmed influenza. In patients with AECOPD plus pneumonia, there was a higher risk of ICU admission for those with laboratory-confirmed influenza compared to those without.
Conclusions: Using different indicators for influenza as the likely cause of AECOPD, we found no consistent evidence of worse outcomes of AECOPD due to influenza. Assuming that most of these patients received corticosteroids, as it is accepted standard of care throughout Switzerland, this study provides important information and supports the current practice of using corticosteroids for AECOPD independent of the influenza status.