Ferrer Miquel, Torres Antoni, Martínez Raquel, Ramírez Paula, Polverino Eva, Montull Beatriz, Sialer Salvador, Niederman Michael S, Agusti Alvar, Menéndez Rosario
Department of Pneumology, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
Respirology. 2014 Aug;19(6):929-35. doi: 10.1111/resp.12324. Epub 2014 Jun 9.
The previous use of inhaled corticosteroids (ICS) may reduce the inflammatory response and mortality in patients with community-acquired pneumonia (CAP).
We measured serum levels of several inflammatory biomarkers, as well as mortality at various time-points, in 663 consecutive patients hospitalized for CAP; 128 (19%) were receiving chronic outpatient treatment with ICS. Patients on previous oral corticosteroids were excluded from the analysis.
On admission, patients treated with ICS were older; had been diagnosed with chronic obstructive pulmonary disease (COPD), asthma and pneumonia in the previous year more often; and had higher CAP severity risk classes and lower tumour necrosis factor (TNF)-alpha (P < 0.001) and interleukin (IL)-6 (P = 0.015) serum levels. After adjusting for potential confounders, this association persisted for TNF-alpha (P < 0.001), but not for IL-6. Mortality at 30 and 90 days tended to be lower in patients treated with ICS (P = 0.062 and 0.050, respectively), but mortality was similar after 1 year in both groups (16, 13% vs 81, 15% for patients treated and not treated with ICS, respectively). Hospital readmission rate after 1 year was higher in patients treated with ICS (49, 38% vs 109, 20%, P < 0.001). The association of ICS treatment with a previous diagnosis of pneumonia, lower levels of TNF-alpha and IL-6 on admission and higher readmission rates during follow up persisted in the subpopulation of 210 patients with COPD.
Previous use of ICS in patients hospitalized for CAP is associated with a reduced systemic inflammatory response without any impact on long-term mortality.
既往使用吸入性糖皮质激素（ICS）可能会降低社区获得性肺炎（CAP）患者的炎症反应及死亡率。
我们对663例因CAP住院的连续患者，测定了几种炎症生物标志物的血清水平以及不同时间点的死亡率；其中128例（19%）正在接受ICS的慢性门诊治疗。既往接受口服糖皮质激素治疗的患者被排除在分析之外。
入院时，接受ICS治疗的患者年龄较大；前一年被诊断患有慢性阻塞性肺疾病（COPD）、哮喘和肺炎的频率更高；CAP严重程度风险分级更高，肿瘤坏死因子（TNF）-α（P<0.001）和白细胞介素（IL）-6（P=0.015）血清水平更低。在对潜在混杂因素进行校正后，这种关联在TNF-α方面仍然存在（P<0.001），但在IL-6方面不存在。接受ICS治疗的患者在30天和90天时的死亡率倾向于更低（分别为P=0.062和0.050），但两组在1年后的死亡率相似（接受ICS治疗和未接受ICS治疗的患者分别为16.13%和81.15%）。接受ICS治疗的患者1年后的医院再入院率更高（49.38%对109.20%，P<0.001）。在210例COPD患者的亚组中，ICS治疗与既往肺炎诊断、入院时较低的TNF-α和IL-6水平以及随访期间较高的再入院率之间的关联仍然存在。
因CAP住院患者既往使用ICS与全身炎症反应降低相关，且对长期死亡率无任何影响。
