Department of Pulmonology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, 296-8602, Chiba, Japan.
Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
BMC Infect Dis. 2024 Nov 2;24(1):1233. doi: 10.1186/s12879-024-10151-3.
A recent database study and meta-analysis reported that adjunctive glucocorticoid therapy reduces mortality in patients with non-human immunodeficiency virus-associated (non-HIV) Pneumocystis jirovecii pneumonia (PCP), having hypoxemia. However, the optimal glucocorticoid dose remains unclear. Our study aimed to evaluate the effectiveness of pulse methylprednisolone compared with mild-to-moderate steroid doses in patients with non-HIV PCP.
This multicentre retrospective cohort study included adults with non-HIV PCP receiving adjunctive steroids at three Japanese tertiary care hospitals from June 2006 to March 2021. Patients were categorised into pulse methylprednisolone and mild-to-moderate dose groups. Pulse methylprednisolone involved an initial intravenous infusion of 500-1000 mg methylprednisolone daily, while the mild-to-moderate dose was lower. Primary and secondary outcomes were 30-day and 180-day mortality from treatment initiation. Patient characteristics were adjusted using propensity score analysis with overlap weighting. Subgroup analysis focused on patients with respiratory failure.
The study included 139 patients with non-HIV PCP: 55 in the pulse methylprednisolone group and 84 in the mild-to-moderate dose group. After adjusting for patient background, 30-day mortality (14.2% vs. 15.5%, P = 0.850) and 180-day mortality (33.5% vs. 27.3%, P = 0.516) did not differ significantly between groups. Subgroup analysis revealed no significant associations among patients with respiratory failure.
After adjusting for patient characteristics, no difference in prognosis was observed between pulse methylprednisolone and mild-to-moderate dose groups in patients with non-HIV PCP. A mild-to-moderate dose of adjunctive corticosteroid may suffice for treating non-HIV PCP.
最近的一项数据库研究和荟萃分析报告称，辅助糖皮质激素治疗可降低伴有低氧血症的非人类免疫缺陷病毒相关性（非 HIV）卡氏肺孢子菌肺炎（PCP）患者的死亡率。然而，最佳的糖皮质激素剂量仍不清楚。我们的研究旨在评估脉冲甲泼尼龙与轻度至中度剂量类固醇在非 HIV PCP 患者中的疗效。
这项多中心回顾性队列研究纳入了 2006 年 6 月至 2021 年 3 月期间在日本三家三级保健医院接受辅助类固醇治疗的非 HIV PCP 成年患者。患者被分为脉冲甲泼尼龙和轻度至中度剂量组。脉冲甲泼尼龙方案包括初始静脉输注每日 500-1000mg 甲泼尼龙，而轻度至中度剂量较低。主要和次要结局是从治疗开始起 30 天和 180 天的死亡率。使用重叠加权的倾向评分分析调整患者特征。亚组分析侧重于呼吸衰竭患者。
该研究纳入了 139 例非 HIV PCP 患者：脉冲甲泼尼龙组 55 例，轻度至中度剂量组 84 例。在调整了患者背景后，两组的 30 天死亡率（14.2%比 15.5%，P=0.850）和 180 天死亡率（33.5%比 27.3%，P=0.516）没有显著差异。亚组分析显示呼吸衰竭患者之间没有显著关联。
在调整了患者特征后，非 HIV PCP 患者中脉冲甲泼尼龙和轻度至中度剂量组的预后没有差异。辅助使用轻度至中度剂量的皮质类固醇可能足以治疗非 HIV PCP。
