Department of Pulmonary and Critical Care Medicine, Jinhua Municipal Central Hospital, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, China.
School of Medicine, Shaoxing University, Shaoxing, 312000, Zhejiang Province, China.
Sci Rep. 2024 Nov 3;14(1):26502. doi: 10.1038/s41598-024-78233-5.
Corticosteroid is essential in the treatment regimen for connective tissue disease (CTD); however, its long-term use poses significant risks, including pulmonary infections. The relationship between cumulative corticosteroid doses and adverse pneumonia outcomes requires further investigation. This study aimed to explore the association between cumulative methylprednisolone dosages (CMD) and pneumonia mortality risks among CTD patients. We conducted a retrospective analysis of data from CTD patients treated with intravenous or oral corticosteroids across six academic hospitals over approximately five years in China. We evaluated follow-up outcomes at 30 and 90 days after the onset of pneumonia. Piecewise linear regression, Cox regression analysis, and survival analysis were employed to investigate the relationship between CMD and 30-day and 90-day mortality risks. Among 335 CTD patients with pneumonia, the mean CMD was 12 g. The 30-day and 90-day mortality rates were 25.07% and 29.55%, respectively. After adjusting for potential confounders, smooth curve fitting analysis revealed a specific nonlinear relationship between CMD and 30-day and 90-day mortality risks. Cox regression analysis indicated that the lowest pneumonia mortality risk occurred when CMD ranged from 11 to 24 g (30-day adjusted hazard ratio (aHR) 0.33, 95% CI 0.14-0.77; 90-day aHR 0.37, 95% CI 0.17-0.81). Patients in the 11-24 g CMD group demonstrated significantly lower cumulative hazard and death rates compared to both the low CMD (< 11 g) and high CMD (> 24 g) groups (P < 0.05). Furthermore, interaction testing suggested that CMD's negative impact on pneumonia mortality risks was more pronounced in community-acquired pneumonia (CAP) compared to hospital-acquired pneumonia (P for interaction < 0.05). CMD shows a distinct nonlinear relationship with 30-day and 90-day pneumonia mortality risks, with potentially lower risks observed within the 11-24 g CMD range. Moreover, the varying impact of CMD on CAP mortality risk warrants further consideration in clinical management strategies.
皮质类固醇在结缔组织病（CTD）的治疗方案中必不可少；然而，其长期使用存在重大风险，包括肺部感染。累积皮质类固醇剂量与不良肺炎结局之间的关系需要进一步研究。本研究旨在探讨累积甲泼尼龙剂量（CMD）与 CTD 患者肺炎死亡风险之间的关系。我们对中国六所学术医院近五年内接受静脉或口服皮质类固醇治疗的 CTD 患者进行了回顾性分析。我们评估了肺炎发病后 30 天和 90 天的随访结果。分段线性回归、Cox 回归分析和生存分析用于研究 CMD 与 30 天和 90 天死亡率风险之间的关系。在 335 名患有肺炎的 CTD 患者中，平均 CMD 为 12g。30 天和 90 天的死亡率分别为 25.07%和 29.55%。调整潜在混杂因素后，平滑曲线拟合分析显示 CMD 与 30 天和 90 天死亡率风险之间存在特定的非线性关系。Cox 回归分析表明，当 CMD 范围在 11 至 24g 时，肺炎死亡率风险最低（30 天校正后的危险比（aHR）0.33，95%置信区间（CI）0.14-0.77；90 天 aHR 0.37，95%CI 0.17-0.81）。与低 CMD（<11g）和高 CMD（>24g）组相比，CMD 为 11-24g 的患者的累积危险度和死亡率明显更低（P<0.05）。此外，交互测试表明，CMD 对肺炎死亡率风险的负面影响在社区获得性肺炎（CAP）中比医院获得性肺炎（HAP）更为显著（P 交互<0.05）。CMD 与 30 天和 90 天肺炎死亡率风险呈明显非线性关系，在 11-24g CMD 范围内可能风险较低。此外，CMD 对 CAP 死亡率风险的影响存在差异，这在临床管理策略中值得进一步考虑。
