Corticosteroid use in the intensive care unit: at what cost?

Arch Surg. 2006 Feb;141(2):145-9; discussion 149. doi: 10.1001/archsurg.141.2.145.


Hypothesis: Corticosteroid use has a significant effect on morbidity and mortality in the intensive care unit (ICU).

Design: Case-control study.

Setting: Burn-trauma ICU in a level 1 trauma center.

Patients: All patients who received corticosteroids while in the ICU from January 1, 2002, to December 31, 2003 (n = 100), matched by age and Injury Severity Score with a control group (n = 100).

Interventions: None.

Main outcome measures: We considered the following 7 outcomes: pneumonia, bloodstream infection, urinary tract infection, other infections, ICU length of stay (LOS), ventilator LOS, and mortality.

Results: Cases and controls had similar APACHE II (Acute Physiology and Chronic Health Evaluation II) scores and medical history. In univariate analysis, the corticosteroid group had a significant increase in pneumonia (26% vs 12%; P<.01), bloodstream infection (19% vs 7%; P<.01), and urinary tract infection (17% vs 8%; P<.05). In multivariate models, corticosteroid use was associated with an increased rate of pneumonia (odds ratio [OR], 2.64; 95% confidence interval [CI], 1.21-5.75) and bloodstream infection (OR, 3.25; 95% CI, 1.26-8.37). There was a trend toward increased urinary tract infection (OR, 2.31; 95% CI, 0.94-5.69), other infections (OR, 2.57; 95% CI, 0.87-7.67), and mortality (OR, 1.89; 95% CI, 0.81-4.40). Patients in the ICU who received corticosteroids had a longer ICU LOS by 7 days (P<.01) and longer ventilator LOS by 5 days (P<.01).

Conclusions: Corticosteroid use is associated with increased rate of infection, increased ICU and ventilator LOS, and a trend toward increased mortality. Caution must be taken to carefully consider the indications, risks, and benefits of corticosteroids when deciding on their use.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Burn Units / statistics & numerical data*
  • Follow-Up Studies
  • Glucocorticoids / therapeutic use*
  • Hospital Mortality / trends*
  • Humans
  • Incidence
  • Length of Stay / statistics & numerical data
  • Length of Stay / trends*
  • Middle Aged
  • Pneumonia / epidemiology
  • Pneumonia / prevention & control*
  • Retrospective Studies
  • Sepsis / epidemiology
  • Sepsis / prevention & control*
  • Treatment Outcome
  • Urinary Tract Infections / epidemiology
  • Urinary Tract Infections / prevention & control*


  • Glucocorticoids