Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, 155 Hanzhong Road, Nanjing, Jiangsu Province, 210029, People's Republic of China.
School of Chinese Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Road, Nanjing, Jiangsu Province, 210029, People's Republic of China.
BMC Med. 2024 Oct 23;22(1):488. doi: 10.1186/s12916-024-03705-4.
Systemic corticosteroid has been recommended for the treatment of severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Little is known about the use of systemic corticosteroid in patients admitted to intensive care units (ICU) since most of previous trials excluded these critically ill patients.
We conducted a matched cohort study based on the Medical Information Mart in Intensive Care-IV database. Patients with AECOPD in ICUs were included. Patients in the exposure group should be intravenously administrated with methylprednisolone or treated with oral prednisone within 24 h after ICU admission. The propensity score matching and multivariable analyses were used to adjust for covariates. The primary outcome was 28-day mortality, and secondary outcomes included ICU mortality, in-hospital mortality, the duration of ICU stay, and mechanical ventilation. Subgroup analyses for the primary outcome were performed according to age, sex, type of corticosteroid, type of ICU admission, type of mechanical ventilation, and co-morbidities/complications.
The entire cohort and the matched cohort included 763 and 412 patients, respectively. In the matched cohort, the use of systemic corticosteroid had no impact on 28-day mortality (OR: 1.00, 95% CI: 0.61-1.64, P = 1.000). The results kept consistent in all subgroups. Additionally, systemic corticosteroid showed no benefits on ICU mortality, in-hospital mortality, the length of ICU stay, and the duration of mechanical ventilation.
The results of this study do not support routine use of systemic corticosteroid in patients with AECOPD admitted to ICUs.
全身皮质类固醇已被推荐用于治疗慢性阻塞性肺疾病（COPD）的急性加重期（AECOPD）。由于大多数先前的试验排除了这些重症患者，因此，对于入住重症监护病房（ICU）的患者使用全身皮质类固醇的情况知之甚少。
我们基于医疗信息集市重症监护-IV 数据库进行了一项匹配队列研究。纳入入住 ICU 的 AECOPD 患者。暴露组患者应在入住 ICU 后 24 小时内静脉注射甲泼尼龙或口服泼尼松龙治疗。采用倾向评分匹配和多变量分析来调整协变量。主要结局为 28 天死亡率，次要结局包括 ICU 死亡率、住院死亡率、ICU 住院时间和机械通气时间。根据年龄、性别、皮质类固醇类型、入住 ICU 类型、机械通气类型和合并症/并发症进行亚组分析。
整个队列和匹配队列分别纳入 763 例和 412 例患者。在匹配队列中，全身皮质类固醇的使用对 28 天死亡率无影响（OR：1.00，95%CI：0.61-1.64，P=1.000）。在所有亚组中，结果均保持一致。此外，全身皮质类固醇对 ICU 死亡率、住院死亡率、ICU 住院时间和机械通气时间均无获益。
本研究结果不支持常规在入住 ICU 的 AECOPD 患者中使用全身皮质类固醇。
