Corticosteroids in Trauma Patients: Impact on Outcomes and Infection Risk

Authors:
Ameera Mazraany, George C Velmahos, Haytham M A Kaafarani, Ikemsinachi C Nzenwa, John O Hwabejire, Josh Ng, Michael DeWane, Vahe S Panossian, Veerle van Zon

Body of Abstract:
Background: Corticosteroids impair healing and increase infection risk in surgical patients, but their impact on injured patients is less understood. This study aimed to examine the relationship between corticosteroid use and outcomes, including infection, in trauma patients.

Methods: Using the ACS-TQIP 2017-2020 database, all trauma patients 18 years or older were included. Corticosteroid use is defined in the database as the routine use of corticosteroid medications within 30 days before the injury for the management of a chronic medical condition. Multivariable logistic regression adjusting for demographics (e.g. age, sex), injury characteristics (e.g. mechanism, severity), and comorbidities (e.g. COPD, cirrhosis) was used to study the correlation between corticosteroid use and 1) mortality, 2) overall morbidity (e.g. acute kidney injury, stroke, pressure ulcers), and 3) infectious complications (e.g. sepsis, pneumonia, surgical site infection- SSI). SSI was assessed only in patients who underwent open surgical procedures.

Results: A total of 3,278,447 patients were included, 33,977 (1.0%) of which were corticosteroid users. The median age was 54 years, 90.3% had blunt trauma, mortality was 3.5%, overall morbidity was 7.3%, and 0.9% of patients developed an infectious complication. Among those who underwent open surgery, 0.6% developed a SSI. On multivariable analyses, corticosteroid use was independently associated with increased odds of mortality (OR 1.49, 95% CI 1.38–1.60, p<0.001), overall morbidity (OR 1.29, 95% CI 1.24–1.34, p<0.001) and infectious complications (OR 1.45, 95% CI 1.29–1.63, p<0.001), but not SSI (OR 0.81, 95% CI 0.55–1.18, p=0.270) [Figure 1]. Conclusion: Corticosteroid use in trauma patients is independently associated with increased risk of mortality, morbidity and infectious complications. These findings are important for patient counseling, benchmarking the quality of care of trauma patients, and for creating targeted interventions to decrease the risk of complications and infection in this patient population.