因慢性阻塞性肺疾病急性加重住院患者使用大剂量全身性皮质类固醇：一项队列研究。

High doses of systemic corticosteroids in patients hospitalised for exacerbation of chronic obstructive pulmonary disease. A cohort study.

作者信息

Rueda-Camino J A, Bernal-Bello D, Canora-Lebrato J, Velázquez-Ríos L, García de Viedma-García V, Guerrero-Santillán M, Duarte-Millán M A, Cristóbal-Bilbao R, Zapatero-Gaviria A

机构信息

Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.

出版信息

Rev Clin Esp (Barc). 2017 Dec;217(9):504-509. doi: 10.1016/j.rce.2017.07.012. Epub 2017 Aug 31.

DOI:10.1016/j.rce.2017.07.012

PMID:28865758

Abstract

OBJECTIVES

To assess the effect of high doses of corticosteroids in patients hospitalised for exacerbation of chronic obstructive pulmonary disease (COPD).

PATIENTS AND METHODS

A prospective cohort study was conducted on patients hospitalized with COPD between January and March 2015, grouped according to the glucocorticoid dosage administered (cutoff, 40mg of prednisone/day). We compared the results of hospital stay, readmission and mortality at 3 months of discharge.

RESULTS

We analysed 87 patients. The median daily dose was 60mg of prednisone (interquartile range, 46.67-82.33mg/day), and the administration route was intravenous in 96.6% of the cases. We established a relative risk (RR) for hospital stays longer than 8 days of 1.095 (95% CI 0.597-2.007; P=.765) when steroid dosages greater than 40mg/day were employed. In these patients, the hazard ratio (HR) for readmission in the 3 months after discharge was 0.903 (95% CI 0.392-2.082; P=.811), and the mortality was 1.832 (95% CI 0.229-16.645; P=.568). Neither the RR nor the HR varied in a statistically significant manner after adjusting for confounding factors.

CONCLUSIONS

A daily dose greater than 40mg of prednisone in patients hospitalised for COPD exacerbation was not associated with a shorter hospital stay or a reduction in readmissions or mortality at 3 months.

摘要

目的

评估大剂量皮质类固醇对因慢性阻塞性肺疾病（COPD）急性加重而住院患者的影响。

患者与方法

对2015年1月至3月因COPD住院的患者进行了一项前瞻性队列研究，根据给予的糖皮质激素剂量（临界值为泼尼松40mg/天）进行分组。我们比较了出院3个月时的住院时间、再入院率和死亡率结果。

结果

我们分析了87例患者。泼尼松的每日中位剂量为60mg（四分位间距为46.67 - 82.33mg/天），给药途径96.6%为静脉注射。当使用大于40mg/天的类固醇剂量时，我们确定住院时间超过8天的相对风险（RR）为1.095（95%置信区间为0.597 - 2.007；P = 0.765）。在这些患者中，出院后3个月再入院的风险比（HR）为0.903（95%置信区间为0.392 - 2.082；P = 0.811），死亡率为1.832（95%置信区间为0.229 - 16.645；P = 0.568）。在调整混杂因素后，RR和HR均未出现具有统计学意义的变化。