University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, TX, USA.
Ther Adv Respir Dis. 2012 Dec;6(6):323-30. doi: 10.1177/1753465812458985.
Limited information is available regarding the impact of prior outpatient use of systemic corticosteroids (SCS) in patients subsequently developing community-acquired pneumonia (CAP). We investigate the effects of prior SCS on severity of illness, microbiology and clinical outcomes for patients hospitalized with CAP.
A retrospective cohort study of subjects with CAP (according to International Classification of Diseases, 9th edition codes) was conducted over a 3-year period at two tertiary teaching hospitals. Subjects were considered to be SCS users if they received oral corticosteroids prior to admission. Primary outcomes were severity of illness, microbiology and 30-day mortality.
Data were abstracted on 698 patients [prior SCS users, 75 (10.7%) versus prior non-SCS users 623 (89.3%)]. Prior SCS users were more likely to have chronic obstructive pulmonary disease. No differences were found in severity of disease at admission, microbiological etiology including opportunistic and drug-resistant pathogens and clinical outcomes, including 30-day mortality, intensive care unit admission, length of hospital stay, need for mechanical ventilation and need for vasopressors.
Prior SCS use is not associated with increased 30-day mortality for patients hospitalized with CAP. In addition, no differences were found in either the severity of the disease at the time of presentation or in the presence of the resistant or opportunistic pathogens among groups.
关于先前在门诊使用全身性皮质类固醇（SCS）的患者随后发生社区获得性肺炎（CAP）的影响，相关信息有限。我们调查了先前使用 SCS 对因 CAP 住院患者的疾病严重程度、微生物学和临床结局的影响。
对 3 家教学医院在 3 年内因 CAP（根据国际疾病分类，第 9 版代码）住院的患者进行了回顾性队列研究。如果患者在入院前接受过口服皮质类固醇治疗，则被认为是 SCS 使用者。主要结局为疾病严重程度、微生物学和 30 天死亡率。
共纳入 698 例患者[先前使用 SCS 的患者 75 例（10.7%），先前未使用 SCS 的患者 623 例（89.3%）]。先前使用 SCS 的患者更可能患有慢性阻塞性肺疾病。在入院时的疾病严重程度、包括机会性和耐药病原体在内的微生物病因学以及临床结局（包括 30 天死亡率、入住重症监护病房、住院时间、需要机械通气和需要升压药）方面，两组之间均无差异。
先前使用 SCS 与 CAP 住院患者的 30 天死亡率增加无关。此外，在两组中，在就诊时的疾病严重程度或存在耐药或机会性病原体方面均无差异。
