Effects of additive corticosteroid therapy on 90-day survival in patients with community-onset pneumonia |
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| Affiliation: | 1. Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishiku, Kitakyushu City, Fukuoka, 807-8555, Japan;2. Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishiku, Kitakyushu City, Fukuoka, 807-8555, Japan;3. Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan;4. Department of Information Management Center, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishiku, Kitakyushu City, Fukuoka, 807-8555, Japan;5. Department of Environmental Epidemiology, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishiku, Kitakyushu City, Fukuoka, 807-8555, Japan;6. Department of Health Policy and Informatics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, 113-8510, Japan;1. Basaksehir Cam and Sakura City Hospital, Department of Pediatric Hematology- Oncology, Turkey;2. Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency, Turkey;3. Gaziantep University, Faculty of Medicine, Department of Hematology, Turkey;4. Istanbul University, Istanbul Faculty of Medicine, Department of Medical Biology and Genetics, Turkey;5. University of Health Science, Istanbul Training and Research Hospital, Department of Department of Hematology, Turkey;1. Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan;2. Department of Pediatrics, San-Ikukai Hospital, 3-20-2 Taihei, Sumida-ku, Tokyo, 130-0012, Japan;3. Department of Pediatrics, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521, Japan;4. Department of Pediatrics, Tokyo Rinkai Hospital, 1-4-2 Rinkai-cho, Edogawa-ku, Tokyo, 134-0086, Japan;5. Department of Pediatrics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan;6. Department of Pediatrics, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-city, Chiba, 279-0021, Japan;1. Division of Bacteriology, Chiba Prefectural Institute of Public Health, 666-2, Nitona, Chuo, Chiba, 260-8715, Japan;2. Center for Emergency Preparedness and Response, National Institute of Infectious Diseases, 4-7-1, Gakuen, Musashi-murayama, Tokyo, 208-0011, Japan;1. Department of Microbiology, Fujita Health University School of Medicine, Aichi, Japan;2. Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Aichi, Japan;3. Department of Bacteriology, Nagoya University Graduate School of Medicine, Aichi, Japan;4. Department of Medical Sciences, Shinshu University Graduate School of Medicine, Science and Technology, Nagano, Japan;5. Department of Infectious Diseases, Fujita Health University School of Medicine, Aichi, Japan;6. Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA;1. Department of General Internal Medicine, Tenri Hospital, Tenri, Japan;2. Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Japan;3. Corporate office, Tenri Hospital, Tenri, Japan;1. Medicine and Biosystematic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan;2. Japan Physicians Association, Tokyo, Japan;3. Ricerca Clinica Co., Fukuoka, Japan;4. Kawai Clinic, Gifu, Japan;5. Takasaki Clinic: Pediatrics & Child Health, Japan;6. Shindo Children''s Clinic, Japan |
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| Abstract: | IntroductionSystemic corticosteroid therapy is occasionally used as an additive therapy, especially for patients with severe pneumonia. However, its recommendation for use in patients with pneumonia varies worldwide, and its efficacy is unclear.MethodsAdult Japanese patients hospitalized with community-onset pneumonia between January and December 2012 were analyzed using the Diagnostic Procedure Combination database. The patients were classified into mild-to-moderate and severe groups using the A-DROP (age, dehydration, respiration, orientation, and blood pressure) system. The 90-day survival rate was evaluated between the presence or absence of corticosteroid treatment using the Kaplan-Meier method in the overall, mild-to-moderate and severe groups, respectively. The patients’ clinical characteristics were adjusted between the two groups using the inverse probability of treatment weighting method.ResultsAmong 123,811, 110,534 patients were classified as mild-to-moderate grade (corticosteroid group: 8,465, non-corticosteroid group: 102,069) and 13,277 patients were classified as severe grade (corticosteroid group: 1,338, non-corticosteroid group: 11,939). The 90-day survival rate was higher in the non-corticosteroid group than in the corticosteroid group in patients with pneumonia of overall grade (weighted hazard ratio [HR]: 1.36; P < 0.001) and those with mild-to-moderate grade (weighted HR: 1.46; P < 0.001). However, there were no significant differences in the outcomes between the two groups in those with severe grade (weighted HR: 1.08; P = 0.38).ConclusionsAdditive systemic corticosteroid therapy may be related to poor 90-day prognosis in patients with mild-to-moderate grade community-onset pneumonia, although it may not be positively associated with its prognosis in those with severe grade. |
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| Keywords: | Community-onset pneumonia Prognosis Systemic corticosteroid therapy JRS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0030" }," $$" :[{" #name" :" text" ," _" :" Japanese Respiratory Society COP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" community-onset pneumonia DPC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" Diagnostic Procedure Combination IPTW" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" inverse probability of treatment weighting CAP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" community-acquired pneumonia HCAP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" healthcare-associated pneumonia ICU" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" intensive care unit ATS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" American Thoracic Society IDSA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" Infectious Diseases Society of America ICD-10" },{" #name" :" keyword" ," $" :{" id" :" kwrd0130" }," $$" :[{" #name" :" text" ," _" :" International Classification of Diseases 10th revision" },{" #name" :" keyword" ," $" :{" id" :" kwrd0140" }," $$" :[{" #name" :" text" ," _" :" A-DROP (age dehydration" },{" #name" :" keyword" ," $" :{" id" :" kwrd0150" }," $$" :[{" #name" :" text" ," _" :" respiration orientation" },{" #name" :" keyword" ," $" :{" id" :" kwrd0160" }," $$" :[{" #name" :" text" ," _" :" and blood pressure) JCS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0170" }," $$" :[{" #name" :" text" ," _" :" Japan comma scale HR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0180" }," $$" :[{" #name" :" text" ," _" :" hazard ratio CI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0190" }," $$" :[{" #name" :" text" ," _" :" confidence interval RCT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0200" }," $$" :[{" #name" :" text" ," _" :" randomized controlled trial PSI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0210" }," $$" :[{" #name" :" text" ," _" :" Pneumonia Severity Index OR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0220" }," $$" :[{" #name" :" text" ," _" :" odds ratio |
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