Ernst Pierre, Coulombe Janie, Brassard Paul, Suissa Samy
a Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital , Montreal , Quebec , Canada.
b Department of Medicine , Pulmonary Division, Jewish General Hospital , Montreal , Québec , Canada.
COPD. 2017 Apr;14(2):137-142. doi: 10.1080/15412555.2016.1238450. Epub 2016 Dec 23.
The use of oral and inhaled corticosteroids is associated with increases in the risk of infection, especially pneumonia. The risk of sepsis with corticosteroid treatment in patients with chronic obstructive pulmonary disease (COPD) has been little studied, however. We assessed whether the use of inhaled and oral corticosteroids in COPD is associated with an increase in the risk of sepsis. We carried out a retrospective cohort study using the administrative health databases of the province of Quebec, Canada, over the period 1990-2007. The cohort of patients with COPD included patients aged 55 years or older who used respiratory medications. A quasi-cohort analysis was used to estimate the rate ratio (RR) of sepsis in current users of inhaled corticosteroids and oral corticosteroids separately, after adjusting for differences in COPD disease severity and co-morbid conditions. The cohort included 163,514 patients treated for COPD, including 1,704 who were hospitalized for or died with sepsis during follow-up (incidence rate 1.94 per 1000 per year). The RR of sepsis associated with current use of inhaled corticosteroids was 0.98 (95%confidence interval [CI] 0.84-1.14). Current oral corticosteroid use was associated with a 66% increase in the risk of sepsis (RR 1.66; 95% CI: 1.35-2.05). The increase in risk remains for around 5 months after the oral corticosteroid exposure. Among patients treated for COPD, the risk of sepsis is not increased with inhaled corticosteroids, even at high doses, while the risk is increased with oral corticosteroids. This risk should be considered when treating exacerbations of COPD.
口服和吸入皮质类固醇的使用与感染风险增加相关，尤其是肺炎。然而，慢性阻塞性肺疾病（COPD）患者接受皮质类固醇治疗时发生败血症的风险鲜有研究。我们评估了COPD患者使用吸入和口服皮质类固醇是否会增加败血症风险。我们利用加拿大魁北克省1990年至2007年期间的行政卫生数据库进行了一项回顾性队列研究。COPD患者队列包括年龄在55岁及以上且使用呼吸药物的患者。采用准队列分析分别估计吸入皮质类固醇和口服皮质类固醇当前使用者中败血症的发病率比（RR），同时对COPD疾病严重程度和合并症的差异进行了校正。该队列包括163,514例接受COPD治疗的患者，其中1,704例在随访期间因败血症住院或死于败血症（发病率为每年每1000人中有1.94例）。当前使用吸入皮质类固醇与败血症相关的RR为0.98（95%置信区间[CI] 0.84 - 1.14）。当前使用口服皮质类固醇与败血症风险增加66%相关（RR 1.66；95% CI：1.35 - 2.05）。口服皮质类固醇暴露后约5个月风险仍持续增加。在接受COPD治疗的患者中，即使高剂量使用吸入皮质类固醇也不会增加败血症风险，而口服皮质类固醇会增加风险。在治疗COPD急性加重时应考虑这种风险。
