Guo Hui-Jie, Ye Yi-Lu, Cao Rong, Liu Zhi-Hua, He Qun
Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.
Department of Rehabilitation Medicine, Key Laboratory of Biological Targeting Diagnosis, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Front Med (Lausanne). 2023 Jul 20;10:1175855. doi: 10.3389/fmed.2023.1175855. eCollection 2023.
The present study aimed to evaluate the association between the cumulative dose of glucocorticoids (GCs) and case fatality in hospitalized patients who developed pneumonia while receiving glucocorticoid therapy.
This retrospective cohort study included 625 patients receiving long-term GC treatment who were hospitalized with pneumonia (322 male and 303 female). Data were obtained from the Dryad Digital Repository and were used to perform secondary analysis. Multivariable Cox proportional hazard regression model and restricted cubic splines (RCS) were used to evaluate the association between the cumulative dose of GCs and case fatality. Sensitivity analyses and subgroup analyses were performed.
The 30-day and 90-day death rates were 22.9 and 26.2%, respectively. After adjusting for potential confounders, compared with those in the lowest quintile (≤ 1.5 g), the Cox proportional hazard regression model analysis showed that patients with different cumulative doses of GCs (1.5 to 2.95, 2.95 to 5, 5 to 11.5, and > 11.5 g) had lower risks for 30-day death, with respective hazard ratios of 0.86 (95% CI, 0.52 to 1.42), 0.81 (0.49 to 1.33), 0.29 (0.15 to 0.55), and 0.42 (0.22 to 0.79). The multivariable-adjusted RCS analysis suggested a statistically significant N-shaped association between the cumulative dose of GCs and 30-day death. A higher cumulative dose of GC tended to first lead to an increase in 30-day death within 1.8 g, then to a statistically significant decrease until around 8 g [HR for 1 g = 0.82 (0.69 to 0.97)], and again to an increase afterward. Similar results were found in the subgroup analyses and sensitivity analyses.
N-shaped association between the cumulative dose of GCs and case fatality was observed in patients receiving long-term GC treatment who were hospitalized with pneumonia. Our findings may help physicians manage these patients.
本研究旨在评估接受糖皮质激素（GC）治疗的住院患者发生肺炎时，GC累积剂量与病死率之间的关联。
这项回顾性队列研究纳入了625例因肺炎住院且接受长期GC治疗的患者（男性322例，女性303例）。数据取自Dryad数字资源库并用于二次分析。采用多变量Cox比例风险回归模型和限制性立方样条（RCS）评估GC累积剂量与病死率之间的关联。进行了敏感性分析和亚组分析。
30天和90天死亡率分别为22.9%和26.2%。在对潜在混杂因素进行校正后，与最低五分位数组（≤1.5 g）相比，Cox比例风险回归模型分析显示，不同GC累积剂量组（1.5至2.95、2.95至5、5至11.5以及>11.5 g）的患者30天死亡风险较低，相应的风险比分别为0.86（95%CI，0.52至1.42）、0.81（0.49至1.33）、0.29（0.15至0.55）和0.42（0.22至0.79）。多变量校正的RCS分析表明，GC累积剂量与30天死亡之间存在统计学上显著的N形关联。较高的GC累积剂量在1.8 g以内往往首先导致30天死亡增加，然后在达到约8 g之前出现统计学上显著的下降[1 g时的风险比=0.82（0.69至0.97）]，之后再次上升。亚组分析和敏感性分析也发现了类似结果。
在因肺炎住院且接受长期GC治疗的患者中，观察到GC累积剂量与病死率之间存在N形关联。我们的研究结果可能有助于医生管理这些患者。
