Corticosteroids in treatment of aspiration-related acute respiratory distress syndrome: results of a retrospective cohort study

BACKGROUND Acute stroke patients suffering from aspiration may present with acute respiratory distress syndrome (ARDS). There is still a lack of convincing data about the efficacy of corticosteroids in the treatment of aspiration-related ARDS. Therefore, we evaluated the clinical impact of corticosteroids on aspiration-related ARDS. METHODS Between 2012 and 2014, we conducted a retrospective study among acute stroke patients diagnosed with aspiration-related ARDS. The data analyzed included demographic characteristics, clinical manifestations, laboratory examinations, chest imaging, and hospital discharge status. RESULTS Seventy-three acute stroke patients were diagnosed with aspiration-related ARDS. The hospital mortality rate was 39.7%. Corticosteroids were administered in 47 patients (64.4%). The mean dosage was 1.14 (standard deviation [SD] 0.47) mg/kg daily of methylprednisolone (or an equivalent) by intravenous infusion for a period of 7.3 (SD 3.8) days. Ground glass opacities in chest computed tomography images were resolved when corticosteroids were administered. The admission National Institute of Health Stroke Scale score (odds ratio [OR] 5.17, 95% confidence interval [CI] 1.27-10.64) and Acute Physiology and Chronic Health Evaluation II score (OR 2.00, 95% CI 1.12-3.56) were associated with an increased risk of hospital mortality, while albumin (OR 0.81, 95% CI 0.64-0.92) and corticosteroids therapy (OR 0.50, 95% CI 0.35-0.70) were associated with a decreased risk. CONCLUSIONS Low-dose and short-term corticosteroid therapy may have an impact on survival in aspiration-related ARDS. The presence of ground glass opacities on the chest computed tomography, performed to rule out aspiration-related ARDS, could be translated into an increased possibility of positive response to corticosteroid therapy.