Wang Saibin, Ye Qian
Department of Pulmonary and Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, China.
School of Medicine, Shaoxing University, Shaoxing, Zhejiang Province, China.
Front Pharmacol. 2024 Sep 19;15:1445979. doi: 10.3389/fphar.2024.1445979. eCollection 2024.
The impact of glucocorticoid use on mortality risk in pneumonia patients remains unclear. This study aimed to investigate the relationship between the accumulated dose of glucocorticoids (ADG) and secondary pneumonia mortality risk among patients receiving oral or intravenous glucocorticoids.
Data from the DRYAD database were analyzed, covering pneumonia patients from six academic hospitals over a 5-year period who had been administered oral or intravenous glucocorticoids. Piecewise linear regression and multivariate regression analysis were utilized to assess the association between ADG and mortality risk in pneumonia patients, while adjusting for potential confounders.
Among the 628 pneumonia patients included, the 30-day mortality rate was 23.1% and the 90-day mortality rate was 26.4%. In the high-dose glucocorticoid group (≥24 mg/day of methylprednisolone or an equivalent glucocorticoid within 30 days before admission), the 30-day and 90-day mortality rates were 31.2% and 35.9%, respectively. Piecewise linear regression analysis demonstrated a non-linear relationship between ADG and mortality risk in pneumonia patients. Multivariate regression analysis revealed a significantly lower mortality risk in patients receiving an ADG of 20-39 g methylprednisolone compared to those receiving lower (<20 g) or higher doses (≥40 g), after adjusting for potential confounding factors. Additionally, in the high-dose glucocorticoid group, surpassing the inflection point of 20 g of methylprednisolone raised the 30-day and 90-day mortality risks (adjusted odds ratio, 95% confidence interval: 1.16, 1.03-1.30 and 1.23, 1.07-1.42, respectively). Notably, this threshold effect was observed exclusively in male patients.
This study provides evidence supporting a potential threshold effect between ADG and mortality risk in oral or intravenous glucocorticoid users with secondary pneumonia. Specifically, male patients receiving high-dose glucocorticoids should undergo close monitoring when the ADG of methylprednisolone exceeds 20 g, as it may be associated with an elevated risk of mortality.
糖皮质激素的使用对肺炎患者死亡风险的影响仍不明确。本研究旨在探讨口服或静脉使用糖皮质激素患者中糖皮质激素累积剂量（ADG）与继发性肺炎死亡风险之间的关系。
分析DRYAD数据库的数据，涵盖6家学术医院5年间接受口服或静脉糖皮质激素治疗的肺炎患者。采用分段线性回归和多变量回归分析评估ADG与肺炎患者死亡风险之间的关联，同时对潜在混杂因素进行校正。
纳入的628例肺炎患者中，30天死亡率为23.1%，90天死亡率为26.4%。在高剂量糖皮质激素组（入院前30天内甲基强的松龙≥24mg/天或等效糖皮质激素）中，30天和90天死亡率分别为31.2%和35.9%。分段线性回归分析显示ADG与肺炎患者死亡风险之间存在非线性关系。多变量回归分析显示，在调整潜在混杂因素后，接受20 - 39g甲基强的松龙ADG的患者死亡风险显著低于接受较低（<20g）或较高剂量（≥40g）的患者。此外，在高剂量糖皮质激素组中，超过20g甲基强的松龙的拐点会增加30天和90天的死亡风险（校正比值比，95%置信区间：分别为1.16，1.03 - 1.30和1.23，1.07 - 1.42）。值得注意的是，这种阈值效应仅在男性患者中观察到。
本研究提供了证据支持口服或静脉使用糖皮质激素的继发性肺炎患者中ADG与死亡风险之间存在潜在阈值效应。具体而言，甲基强的松龙ADG超过20g时，接受高剂量糖皮质激素的男性患者应密切监测，因为这可能与死亡风险升高有关。
