Division of Infectious Diseases, Children's Hospital of Philadelphia, Room 1526, North Campus, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
Pediatrics. 2011 Feb;127(2):e255-63. doi: 10.1542/peds.2010-0983. Epub 2011 Jan 10.
To determine if systemic corticosteroid therapy is associated with improved outcomes for children hospitalized with community-acquired pneumonia (CAP).
In this multicenter, retrospective cohort study we used data from 36 children's hospitals for children aged 1 to 18 years with CAP. Main outcome measures were length of stay (LOS), readmission, and total hospitalization cost. The primary exposure was the use of adjunct systemic corticosteroids. Multivariable regression models and propensity scores were used to adjust for confounders.
The 20 703 patients whose data were included had a median age of 4 years. Adjunct corticosteroid therapy was administered to 7234 patients (35%). The median LOS was 3 days, and 245 patients (1.2%) required readmission. Systemic corticosteroid therapy was associated with shorter LOS overall (adjusted hazard ratio [HR]: 1.24 [95% confidence interval (CI): 1.18-1.30]). Among children who received treatment with β-agonists, the LOS was shorter for children who had received corticosteroids compared with children who had not (adjusted HR: 1.36 [95% CI: 1.28-1.45]). Among children who did not receive β-agonists, the LOS was longer for those who received corticosteroids compared with those who did not (adjusted HR: 0.85 [95% CI: 0.75-0.96]). Corticosteroids were associated with readmission of patients who did not receive concomitant β-agonist therapy (adjusted odds ratio: 1.97 [95% CI: 1.09-3.57]).
For children hospitalized with CAP, adjunct corticosteroids were associated with a shorter hospital LOS among patients who received concomitant β-agonist therapy. Among patients who did not receive this therapy, systemic corticosteroids were associated with a longer LOS and a greater odds of readmission. If β-agonist therapy is considered a proxy for wheezing, our findings suggest that among patients admitted to the hospital with a diagnosis of CAP, only those with acute wheezing benefit from adjunct systemic corticosteroid therapy.
确定全身性皮质类固醇治疗是否与改善社区获得性肺炎（CAP）住院儿童的结局相关。
在这项多中心回顾性队列研究中，我们使用了来自 36 家儿童医院的 1 至 18 岁 CAP 患儿的数据。主要结局指标是住院时间（LOS）、再入院和总住院费用。主要暴露因素是辅助全身皮质类固醇的使用。多变量回归模型和倾向评分用于调整混杂因素。
纳入的 20703 例患者的中位年龄为 4 岁。7234 例患者（35%）接受了辅助皮质类固醇治疗。中位 LOS 为 3 天，245 例（1.2%）患者需要再入院。全身性皮质类固醇治疗总体上与 LOS 缩短相关（校正后的危险比[HR]：1.24[95%置信区间（CI）：1.18-1.30]）。在接受β-激动剂治疗的患儿中，与未接受皮质激素治疗的患儿相比，接受皮质激素治疗的患儿 LOS 更短（校正 HR：1.36[95% CI：1.28-1.45]）。在未接受β-激动剂治疗的患儿中，接受皮质激素治疗的患儿 LOS 较长，与未接受皮质激素治疗的患儿相比（校正 HR：0.85[95% CI：0.75-0.96]）。皮质激素与未接受同时使用β-激动剂治疗的患者的再入院相关（校正优势比：1.97[95% CI：1.09-3.57]）。
对于因 CAP 住院的儿童，辅助皮质类固醇与接受同时使用β-激动剂治疗的患者的住院 LOS 缩短相关。在未接受这种治疗的患者中，全身性皮质类固醇与 LOS 延长和再入院的可能性增加相关。如果β-激动剂治疗被认为是喘息的替代指标，那么我们的研究结果表明，在因 CAP 住院的患者中，只有急性喘息的患者受益于辅助全身皮质类固醇治疗。
