Dept of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Dept of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
Dept of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Eur Respir J. 2015 Feb;45(2):463-72. doi: 10.1183/09031936.00081514. Epub 2014 Oct 16.
The relationship between low-dose corticosteroid use and mortality in patients with severe community-acquired pneumonia (CAP) remains unclear. 6925 patients with severe CAP who received mechanical ventilation with or without shock (defined as use of catecholamines) at 983 hospitals were identified using a Japanese nationwide administrative database. The main outcome measure was 28-day mortality. 2524 patients with severe CAP who received catecholamines were divided into corticosteroid (n=631) and control (n=1893) groups. The 28-day mortality was significantly different between corticosteroid and control groups (unmatched: 24.6% versus 36.3%, p<0.001; propensity score-matched: 25.3% versus 32.6%, p=0.01; inverse probability-weighted: 27.5% versus 34.2%, p<0.001). 4401 patients with severe CAP who did not receive catecholamines were also divided into corticosteroid (n=1112) and control (n=3289) groups. The 28-day mortality was not significantly different between corticosteroid and control groups in propensity score-matched analyses (unmatched: 16.0% versus 19.4%, p=0.01; propensity score-matched: 17.7% versus 15.6%, p=0.22; inverse probability-weighted: 18.8% versus 18.2%, p=0.44). Low-dose corticosteroid use may be associated with reduced 28-day mortality in patients with septic shock complicating CAP.
小剂量皮质类固醇治疗严重社区获得性肺炎（CAP）合并脓毒性休克患者的疗效与死亡率之间的关系仍不清楚。使用日本全国性行政数据库，共确定了 983 家医院收治的 6925 例接受机械通气且伴有或不伴有休克（定义为使用儿茶酚胺）的严重 CAP 患者。主要观察指标为 28 天死亡率。631 例严重 CAP 患者接受儿茶酚胺治疗且使用皮质类固醇（皮质类固醇组），1893 例严重 CAP 患者接受儿茶酚胺治疗且未使用皮质类固醇（对照组）。皮质类固醇组和对照组的 28 天死亡率差异有统计学意义（未匹配：24.6%比 36.3%，P<0.001；倾向评分匹配：25.3%比 32.6%，P=0.01；逆概率加权：27.5%比 34.2%，P<0.001）。4401 例未接受儿茶酚胺治疗的严重 CAP 患者分为皮质类固醇组（n=1112）和对照组（n=3289）。倾向评分匹配分析显示，皮质类固醇组和对照组的 28 天死亡率差异无统计学意义（未匹配：16.0%比 19.4%，P=0.01；倾向评分匹配：17.7%比 15.6%，P=0.22；逆概率加权：18.8%比 18.2%，P=0.44）。小剂量皮质类固醇治疗可能与严重 CAP 合并脓毒性休克患者的 28 天死亡率降低相关。
