Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Tokyo, Japan.
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Laryngoscope. 2023 Feb;133(2):344-349. doi: 10.1002/lary.30110. Epub 2022 Mar 19.
To clarify whether treatment with systemic corticosteroids at a certain dose was associated with better outcomes in patients with epiglottitis requiring airway management (tracheotomy or airway intubation).
This was a retrospective cohort study on patients hospitalized for epiglottitis requiring airway management from a nationwide inpatient database (between July 2010 and March 2019). Patients treated with systemic corticosteroids equivalent to methylprednisolone ≥40 mg/d within 2 days of admission and patients who were not treated with corticosteroids within 2 days of admission were compared after inverse probability of treatment weighting using covariate balancing propensity score. The primary outcome was all-cause 30-day in-hospital mortality, and secondary outcomes included all-cause 7-day in-hospital mortality, length of hospital stay, and total medical cost.
There were 1986 and 1771 patients in the corticosteroid and control groups, respectively. A total of 72 of 3757 (1.9%) patients died within 30 days of admission, including 17 of 1986 (0.9%) patients in the corticosteroid group and 55 of 1771 (3.1%) in the control group (weighted odds ratio, 0.28 [95% confidence interval, 0.11-0.70]; weighted risk difference, -2.2% [-3.2% to -1.3%]). Treatment with corticosteroids was associated with lower total medical costs (weighted median, $6,187 vs. $6,587; weighted difference, $-1,123 [-2,238 to -8]) but not all-cause 7-day in-hospital mortality (weighted odds ratio, 0.63 [0.22-1.82]; weighted risk difference, -0.3% [-0.9 to 0.2]) and length of hospital stay (weighted median, 13 vs. 13 days; weighted difference, -0.2 days [-2.1 to 1.8]).
Systemic corticosteroids may be beneficial to patients with epiglottitis requiring airway management.
3 Laryngoscope, 133:344-349, 2023.
明确在需要气道管理（气管切开术或气道插管）的会厌炎患者中，使用特定剂量的全身皮质类固醇治疗是否与更好的结局相关。
这是一项回顾性队列研究，纳入了全国住院患者数据库中（2010 年 7 月至 2019 年 3 月）因需要气道管理而住院的会厌炎患者。对入院后 2 天内接受全身皮质类固醇（等效于甲泼尼龙≥40mg/d）治疗的患者和入院后 2 天内未接受皮质类固醇治疗的患者进行比较，采用逆概率治疗加权法进行协变量平衡倾向评分后比较。主要结局为全因 30 天院内死亡率，次要结局包括全因 7 天院内死亡率、住院时间和总医疗费用。
皮质类固醇组和对照组分别有 3757 例和 1771 例患者。共有 1986 例患者中的 72 例（1.9%）在入院后 30 天内死亡，包括皮质类固醇组的 17 例（0.9%）和对照组的 55 例（3.1%）（加权比值比，0.28[95%置信区间，0.11-0.70]；加权风险差异，-2.2%[-3.2%至-1.3%]）。皮质类固醇治疗与较低的总医疗费用相关（加权中位数，6187 美元比 6587 美元；加权差异，-1123 美元[-2238 美元至-887 美元]），但与全因 7 天院内死亡率（加权比值比，0.63[0.22-1.82]；加权风险差异，-0.3%[-0.9%至 0.2%]）和住院时间（加权中位数，13 天比 13 天；加权差异，-0.2 天[-2.1 天至 1.8 天]）无关。
全身皮质类固醇可能对需要气道管理的会厌炎患者有益。
3 级 Laryngoscope, 133:344-349, 2023.
