Scholl Tyler, Kiser Tyree H, Vondracek Sheryl F
1-University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora.
Chronic Obstr Pulm Dis. 2018 Jan 24;5(1):57-65. doi: 10.15326/jcopdf.5.1.2017.0157.
Chronic obstructive pulmonary disease (COPD) and pneumonia are leading causes of morbidity and mortality and are frequently comorbid. Studies of systemic corticosteroids in pneumonia have shown conflicting outcomes, whereas studies in acute exacerbations of COPD (AECOPD) have shown significant benefits. No studies have evaluated systemic corticosteroids in patients with both an AECOPD and pneumonia. To evaluate the use of systemic corticosteroids in patients with both an AECOPD and pneumonia. Patients with a diagnosis of both COPD or obstructive chronic bronchitis with exacerbation and pneumonia admitted to the University of Colorado Hospital between July 1, 2012 and May 20, 2016 were retrospectively evaluated. Patients who received systemic corticosteroids were compared to those that did not. The primary outcome was length of hospital stay (LOHS). Secondary outcomes were in-hospital treatment failure, a composite of intensive care unit (ICU) admission, ventilation, and escalation of steroid therapy, 30-day AECOPD or pneumonia readmission, and 30-day mortality. A total of 138 patients were included-- 89 in the steroid group and 49 in the non-steroid group. No significant differences in baseline characteristic were noted. No difference was seen in mean LOHS (4.7±3.2 versus 4.2±2.1 days, =0.27), in-hospital treatment failure (7% versus 4%, =0.72), 30-day readmission or 30-day mortality between the steroid and non-steroid groups, respectively. There was a difference in mean LOHS for patients with severe pneumonia between the steroid and non-steroid groups (6.0±4.0 versus 4.3±1.8; =0.03). This study suggests that systemic corticosteroids may not provide a clinical benefit to patients with an AECOPD and pneumonia.
慢性阻塞性肺疾病（COPD）和肺炎是发病和死亡的主要原因，且常合并存在。关于全身性皮质类固醇在肺炎中的研究结果相互矛盾，而在慢性阻塞性肺疾病急性加重期（AECOPD）的研究中显示出显著益处。尚无研究评估全身性皮质类固醇在同时患有AECOPD和肺炎的患者中的应用情况。为了评估全身性皮质类固醇在同时患有AECOPD和肺炎的患者中的应用。对2012年7月1日至2016年5月20日期间入住科罗拉多大学医院、诊断为COPD或阻塞性慢性支气管炎急性加重且合并肺炎的患者进行回顾性评估。将接受全身性皮质类固醇治疗的患者与未接受治疗的患者进行比较。主要结局是住院时间（LOHS）。次要结局包括住院治疗失败，这是一个综合指标，包括重症监护病房（ICU）入院、通气和类固醇治疗升级，30天内AECOPD或肺炎再入院，以及30天死亡率。共纳入138例患者，其中类固醇组89例，非类固醇组49例。两组患者的基线特征无显著差异。类固醇组和非类固醇组在平均住院时间（4.7±3.2天对4.2±2.1天，P = 0.27）、住院治疗失败（7%对4%，P = 0.72）、30天再入院率或30天死亡率方面均无差异。类固醇组和非类固醇组中重症肺炎患者的平均住院时间存在差异（6.0±4.0对4.3±1.8；P = 0.03）。本研究表明，全身性皮质类固醇可能不会给同时患有AECOPD和肺炎的患者带来临床益处。
