Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC), As Xubias, A Coruña, España.
Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC), As Xubias, A Coruña, España.
Arch Bronconeumol. 2017 Nov;53(11):611-615. doi: 10.1016/j.arbres.2017.03.012. Epub 2017 Apr 29.
It is not known whether clinical practice guidelines for the treatment of COPD exacerbations with short coursesofsystemic corticosteroids(SC-SCS) are followed in clinical practice.
Prospective, observational cohort study in patients admitted due to severe COPD exacerbation. The primary endpoint was the percentage of patients who received SC-SCS as treatment for severe exacerbation (doses of 200-300mg for 5-6 days). Secondary variables were percentageof patients with duration or reduced dose, dose in the first 24hours, days of intravenous systemic corticosteroids (SCS), and duration of hospital length of stay (LOS). Simple linear regression was performed with LOS as a dependent variable and multivariate analysis with factors associated with LOS.
158 patients were evaluated. 4.4% (7) patients received SC-SCS, 8.7% received a reduced dose and duration was reduced in 15.8%. The median dose and duration of SCS were 602.5mg (200-1625) and 14 (4-36) days, respectively. We observed an association between days of SCSand LOS (P<.001) and doses of intrahospitalSCSand LOS (P<.001). Factors associated with LOS were doses of intrahospitalSCS received (.01 [95% CI:.007-.013]; P<0.001), days of steroid treatment (.14 [95% CI .03-.25], P=.009) and PAFI (pO2/FiO ratio) at admission (-.012 [95% CI: -.012 to -.002], P=.015).
The SCS schedules used in routine clinical practice are longer and administered at a higher dose than recommended, leading toa longer hospital stay.
目前尚不清楚在临床实践中是否遵循了治疗 COPD 加重症的短期全身皮质类固醇（SC-SCS）临床实践指南。
这是一项针对因严重 COPD 加重而入院的患者的前瞻性观察性队列研究。主要终点是接受 SC-SCS 治疗严重加重症的患者比例（剂量为 200-300mg，持续 5-6 天）。次要变量是接受 SC-SCS 治疗的患者的持续时间或剂量减少的比例、第 1 天至第 24 小时的剂量、静脉全身皮质类固醇（SCS）的天数和住院时间（LOS）的持续时间。将 LOS 作为因变量进行简单线性回归，并对与 LOS 相关的因素进行多元分析。
共评估了 158 例患者。4.4%（7 例）患者接受了 SC-SCS，8.7%的患者接受了减少剂量，15.8%的患者持续时间和剂量减少。SCS 的中位剂量和持续时间分别为 602.5mg（200-1625）和 14 天（4-36）。我们观察到 SCS 天数与 LOS 之间存在相关性（P<.001），以及院内 SCS 剂量与 LOS 之间存在相关性（P<.001）。与 LOS 相关的因素包括院内 SCS 剂量（0.01[95%CI：0.007-0.013]；P<0.001）、类固醇治疗天数（0.14[95%CI：0.03-0.25]，P=.009）和入院时 PAFI（pO2/FiO 比值）（-0.012[95%CI：-0.012 至-0.002]，P=.015）。
常规临床实践中使用的 SCS 方案的持续时间更长，剂量更高，导致住院时间延长。
