Pulse Steroid Therapy for Severe Acute Respiratory Distress Syndrome: A Propensity Score-Matched Analysis
Abstract
1. Introduction
2. Materials and Methods
2.1. Setting
2.2. Data Collection
2.3. Patient Selection
2.4. Endpoints
2.5. Statistical Analysis
3. Results
3.1. Patients
3.2. Endpoints
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ARDS | acute respiratory distress syndrome |
BMI | body mass index |
COVID-19 | coronavirus disease 2019 |
COPD | chronic obstructive pulmonary disease |
ECMO | extracorporeal membrane oxygenation |
ECMOFDs | extracorporeal membrane oxygenation-free days |
IQR | interquartile range |
RESP | respiratory extracorporeal membrane oxygenation survival prediction |
SOFA | Sequential Organ Failure Assessment |
SD | standardized difference |
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Variables | Unmatched Group | Matched Group | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
All Patients (n = 373) | Non-Pulse (n = 317) | Pulse (n = 56) | SD | p Value | All Patients (n = 96) | Non-Pulse (n = 48) | Pulse (n = 48) | SD | p Value | |
Demographic factors and severity of illness | ||||||||||
Age, median (IQR), years | 60 (51–67) | 60 (51–67) | 62.5 (52–67) | 0.06 | 0.711 | 62 (48.8–69.3) | 57 (45.8–70.3) | 63 (53.8–67.0) | 0.134 | 0.610 |
male sex, n (%) | 283 (75.9) | 245 (77.3) | 38 (67.9) | 0.213 | 0.131 | 70 (72.9) | 35 (72.9) | 35 (72.9) | <0.001 | 1.000 |
BMI, median (IQR) | 26 (22.8–30.5) | 26.2 (23.2–31.1) | 24.2 (21.5–27.0) | 0.461 | 0.002 | 24.6 (22.2–28.0) | 25.1 (21.4–28.3) | 24.6 (22.4–27.0) | 0.134 | 0.674 |
Causes of ARDS, n (%) | 1.243 | - | 0.368 | 0.871 | ||||||
COVID-19 | 217 (58.2) | 207 (65.3) | 10 (17.9) | 20 (20.8) | 10 (20.8) | 10 (20.8) | ||||
Bacterial | 45 (12) | 31 (9.8) | 14 (25) | 23 (24) | 11 (22.9) | 12 (25.0) | ||||
Extra-pulmonary | 20 (5.4) | 18 (5.7) | 2 (3.6) | 6 (6.3) | 4 (8.3) | 2 (4.2) | ||||
Influenza | 10 (2.7) | 8 (2.5) | 2 (3.6) | 3 (3.1) | 1 (2.1) | 2 (4.2) | ||||
Legionnaires | 5 (1.3) | 5 (1.6) | 0 (0) | 0 (0.0) | 0 (0) | 0 (0) | ||||
Aspiration pneumonitis | 4 (1) | 3 (0.9) | 1 (1.8) | 2 (2.1) | 1 (2.1) | 1 (2.1) | ||||
Trauma | 4 (1) | 3 (0.9) | 1 (1.8) | 2 (2.1) | 2 (4.2) | 0 (0.0) | ||||
Drowning | 1 (4) | 1 (0.3) | 0 (0) | 0 (0.0) | 0 (0) | 0 (0.0) | ||||
Unknown | 67 (18) | 41 (12.9) | 26 (46.4) | 40 (41.7) | 19 (39.6) | 21 (43.8) | ||||
SOFA score, median (IQR) | 10 (8–12) | 9 (7–12) | 11 (8–12) | 0.273 | 0.042 | 11 (8–13) | 11 (8–13) | 11 (8–12) | 0.1 | 0.737 |
RESP score, median (IQR) | 3 (1–4) | 3 (1–4) | 2 (0–4) | 0.111 | 0.300 | 2 (0–4) | 2 (0–4) | 2 (0–4) | 0.22 | 0.408 |
Murray lung injury score, median (IQR) | 13 (11–14) | 13 (11–14) | 13 (11–14) | 0.023 | 0.888 | 13 (11–14) | 13 (11–14) | 13 (11–14) | 0.047 | 0.673 |
Intubation to ECMO start <7 days, n (%) | 310 (83.1) | 262 (82.6) | 48 (85.7) | 0.084 | 0.700 | 82 (85.4) | 42 (87.5) | 40 (83.3) | 0.118 | 0.770 |
Neuromuscular blockers use before ECMO start, n (%) | 177 (47.5) | 153 (48.3) | 24 (42.9) | 0.109 | 0.472 | 39 (40.6) | 21 (43.8) | 18 (37.5) | 0.128 | 0.678 |
Prone therapy before ECMO start, n (%) | 83 (22.3) | 79 (24.9) | 4 (7.1) | 0.499 | 0.003 | 7 (7.3) | 3 (6.2) | 4 (8.3) | 0.08 | 1.000 |
Comorbidities, n (%) | ||||||||||
Diabetes mellitus | 106 (28.4) | 94 (29.7) | 12 (21.4) | 0.189 | 0.261 | 19 (19.8) | 8 (16.7) | 11 (22.9) | 0.157 | 0.609 |
Chronic kidney disease | 32 (8.6) | 27 (8.5) | 5 (8.9) | 0.015 | 1.000 | 7 (7.3) | 3 (6.2) | 4 (8.3) | 0.08 | 1.000 |
Cerebrovascular accident | 32 (8.6) | 25 (7.9) | 5 (8.9) | 0.038 | 0.790 | 10 (10.4) | 5 (10.4) | 5 (10.4) | <0.001 | 1.000 |
Asthma | 27 (7.2) | 22 (6.9) | 5 (8.9) | 0.074 | 0.578 | 8 (8.3) | 5 (10.4) | 3 (6.2) | 0.151 | 0.714 |
COPD | 24 (6.4) | 20 (6.3) | 4 (7.1) | 0.033 | 0.770 | 5 (5.2) | 1 (2.1) | 4 (8.3) | 0.284 | 0.362 |
Collagen disease | 29 (7.8) | 19 (6.0) | 10 (17.9) | 0.372 | 0.005 | 15 (15.6) | 8 (16.7) | 7 (14.6) | 0.057 | 1.000 |
Ischemic heart disease | 21 (5.6) | 18 (5.7) | 3 (5.4) | 0.014 | 1.000 | 5 (5.2) | 2 (4.2) | 3 (6.2) | 0.09 | 1.000 |
Interstitial pneumonia | 22 (5.9) | 15 (4.7) | 7 (12.5) | 0.28 | 0.032 | 12 (12.5) | 6 (12.5) | 6 (12.5) | <0.001 | 1.000 |
Chronic heart failure | 15 (4) | 12 (3.8) | 3 (5.4) | 0.075 | 0.480 | 3 (3.1) | 0 (0) | 3 (6.2) | 0.365 | 0.242 |
Lung cancer | 8 (2.1) | 7 (2.2) | 1 (1.8) | 0.03 | 1.000 | 3 (3.1) | 2 (4.2) | 1 (2.1) | 0.12 | 1.000 |
Cirrhosis | 7 (1.9) | 3 (0.9) | 4 (7.1) | 0.319 | 0.011 | 4 (4.2) | 0 (0) | 4 (8.3) | 0.426 | 0.117 |
Variables | Unmatched Group | Matched Group | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
All Patients (n = 373) | Non-Pulse (n = 317) | Pulse (n = 56) | SD | p Value | All Patients (n = 96) | Non-Pulse (n = 48) | Pulse (n = 48) | SD | p Value | |
Laboratory data at ICU admission, median (IQR) | ||||||||||
WBC, 109/L | 11.8 (8.3–17) | 11.7 (8.2–16.1) | 12.5 (9.5–19.8) | 0.221 | 0.111 | 13.6 (10.4–20.2) | 14.9 (11.5–20.8) | 12.5 (10.3–20.0) | 0.093 | 0.450 |
Platelet count, 109/L | 190 (121–264) | 189 (126–260) | 192 (104–284) | 0.117 | 0.787 | 190 (105–281) | 161 (102–251) | 198 (123–288) | 0.22 | 0.206 |
CRP, mg/dL | 10.6 (4.3–19) | 10.4 (4.2–18.4) | 12.4 (4.8–21.1) | 0.185 | 0.233 | 12.2 (6.0–20.6) | 10.9 (6.1–20.2) | 12.5 (5.6–20.7) | 0.022 | 0.826 |
D-dimer, μg/mL | 5.9 (2.5–16) | 5.5 (2.3–15.3) | 9.6 (4.3–32.1) | 0.115 | 0.028 | 8.5 (3.8–30.1) | 7.9 (3.4–26.1) | 9.4 (4.2–33.8) | 0.17 | 0.575 |
Arterial gas data before starting ECMO | ||||||||||
pH | 7.32 (7.22–7.39) | 7.33 (7.23–7.39) | 7.3 (7.2–7.4) | 0.017 | 0.777 | 7.32 (7.21–7.39) | 7.32 (7.23–7.38) | 7.31 (7.21–7.39) | 0.061 | 0.834 |
PaO2, mmHg | 72.9 (60–89.6) | 72.9 (60–87.5) | 73 (59.5–90.4) | 0.029 | 0.954 | 69.8 (59.0–91.1) | 70.4 (58.7–93.3) | 69.6 (60.0–89.8) | 0.022 | 0.783 |
PaCO2, mmHg | 50 (41–64.5) | 50 (41–63) | 49.2 (41–64.6) | 0.084 | 0.887 | 49.4 (41.0–64.6) | 49.0 (41.0–62.4) | 50.1 (40.8–65.1) | 0.163 | 0.703 |
HCO3−, mmol/L | 26 (22.1–29) | 26 (22–29) | 26 (22.8–30.6) | 0.093 | 0.528 | 25.7 (22.4–30.2) | 25.0 (21.3–29.0) | 26.0 (22.7–31.0) | 0.205 | 0.234 |
Other therapeutic intervention, n (%) | ||||||||||
Steroid therapy | 3.053 | - | 2.944 | <0.001 | ||||||
Dexamethasone | 173 (46.4) | 173 (54.6) | 0 (0) | 13 (13.5) | 13 (27.1) | 0 (0) | ||||
Methylprednisolone | 112 (30) | 56 (17.7) | 56 (100) | 57 (59.4) | 9 (18.8) | 48 (100) | ||||
Hydrocortisone | 31 (8.3) | 41 (12.9) | 0 (0) | 13 (13.5) | 13 (27.1) | 0 (0) | ||||
Prednisolone | 37 (9.9) | 37 (11.7) | 0 (0) | 12 (12.5) | 12 (25.0) | 0 (0) | ||||
Betamethasone | 10 (2.7) | 10 (3.2) | 0 (0) | 1 (1.0) | 1 (2.1) | 0 (0) | ||||
RRT | 139 (37.3) | 118 (37.2) | 21 (37.5) | 0.006 | 1.000 | 40 (41.7) | 24 (50.0) | 16 (33.3) | 0.343 | 0.147 |
Prone therapy | 137 (36.7) | 127 (40.1) | 10 (17.9) | 0.505 | 0.001 | 18 (18.8) | 11 (22.9) | 7 (14.6) | 0.215 | 0.433 |
Neuromuscular blockers use | 237 (63.5) | 206 (65) | 31 (55.4) | 0.198 | 0.178 | 58 (60.4) | 32 (66.7) | 26 (54.2) | 0.258 | 0.297 |
Drug Name | Number (%) | Dose (mg) |
---|---|---|
Hydrocortisone | 13 (27.1) | |
8 | 200 | |
2 | 300 | |
1 | 100 | |
1 | 60 | |
1 | 44 | |
Dexamethasone | 13 (27.1) | |
7 | 6.6 | |
3 | 20 | |
2 | 7 | |
1 | 6 | |
Prednisolone | 12 (25.0) | |
3 | 80 | |
3 | 60 | |
2 | 30 | |
1 | 90 | |
1 | 70 | |
1 | 40 | |
1 | 20 | |
Methylprednisolone | 9 (18.8) | |
3 | 80 | |
2 | 40 | |
1 | 500 | |
1 | 160 | |
1 | 88 | |
1 | 50 | |
Betamethasone | 1 (2.0) | |
1 | 16 |
Variable | Unmatched Group | Matched Group | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Non-Pulse (n = 317) | Pulse (n = 56) | OR | 95%CI | p Value | Non-Pulse (n = 48) | Pulse (n = 48) | OR | 95%CI | p Value | |
All-cause hospital mortality, n (%) | 109 (34.4) | 23 (41.1) | 0.75 | 0.41–1.41 | 0.36 | 23 (47.9) | 20 (41.7) | 1.28 | 0.53–3.12 | 0.68 |
ECMOFDs on 28 days, median (IQR), days | 15 (0–20) | 11 (0–18) | 0.24 | 3 (0–17) | 9.5 (0–17.3) | 0.69 | ||||
Adverse events | ||||||||||
Blood culture positive, n (%) | 99 (31.2) | 5 (8.9) | 0.22 | 0.07–0.56 | <0.001 | 11 (22.9) | 5 (10.4) | 0.39 | 0.09–1.37 | 0.17 |
Intracranial bleeding, n (%) | 10 (3.2) | 1 (1.8) | 0.56 | 0.01–4.07 | 1 | 2 (4.2) | 1 (2.1) | 0.49 | 0.01–9.77 | 1 |
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Share and Cite
Kawano, Y.; Maruyama, J.; Nishikimi, M.; Arima, H.; Irie, Y.; Morimoto, S.; Muranishi, K.; Nakashio, M.; Nakamura, Y. Pulse Steroid Therapy for Severe Acute Respiratory Distress Syndrome: A Propensity Score-Matched Analysis. J. Clin. Med. 2025, 14, 5547. https://doi.org/10.3390/jcm14155547
Kawano Y, Maruyama J, Nishikimi M, Arima H, Irie Y, Morimoto S, Muranishi K, Nakashio M, Nakamura Y. Pulse Steroid Therapy for Severe Acute Respiratory Distress Syndrome: A Propensity Score-Matched Analysis. Journal of Clinical Medicine. 2025; 14(15):5547. https://doi.org/10.3390/jcm14155547
Chicago/Turabian StyleKawano, Yasumasa, Junichi Maruyama, Mitsuaki Nishikimi, Hisatomi Arima, Yuhei Irie, Shinichi Morimoto, Kentaro Muranishi, Maiko Nakashio, and Yoshihiko Nakamura. 2025. "Pulse Steroid Therapy for Severe Acute Respiratory Distress Syndrome: A Propensity Score-Matched Analysis" Journal of Clinical Medicine 14, no. 15: 5547. https://doi.org/10.3390/jcm14155547
APA StyleKawano, Y., Maruyama, J., Nishikimi, M., Arima, H., Irie, Y., Morimoto, S., Muranishi, K., Nakashio, M., & Nakamura, Y. (2025). Pulse Steroid Therapy for Severe Acute Respiratory Distress Syndrome: A Propensity Score-Matched Analysis. Journal of Clinical Medicine, 14(15), 5547. https://doi.org/10.3390/jcm14155547