Xue S F, Ren J H, Chen L J, Zhao X Q, Yang T, Hu J D
Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, China Department of Hematology-Oncology, Fujian Children's Hospital, Fuzhou 350014, China.
Department of Hematology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350209, China Department of Hematology, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China Institute of Precision Medicine, Fujian Medical University, Fuzhou 350122, China.
Zhonghua Xue Ye Xue Za Zhi. 2024 Nov 14;45(11):1035-1042. doi: 10.3760/cma.j.cn121090-20240624-00234.
This study aimed to investigate the clinical value of glucocorticoids in patients with neutropenic severe pneumonia at moderate to high risk according to the Pneumonia Severity Index (PSI) in patients with hematologic diseases. Clinical data were collected from 534 patients at the Fujian Medical University Union Hospital from October 2016 to December 2018. We evaluated the changes in inflammatory cytokines, treatment failure, in-hospital mortality, and other outcomes, adjusting for potential confounders through propensity score matching. Patients were categorized into glucocorticoids (=176) and control (=358) groups. The glucocorticoid group demonstrated higher levels of C-reactive protein, procalcitonin, and interleukin-6, alongside higher PSI scores. The differences in comorbidities diminished, except for inflammatory cytokine levels, with a notable reduction in inflammatory cytokines observed in the glucocorticoid group, after matching 125 pairs based on propensity scores. Late treatment failure was more prevalent in the glucocorticoid group (39.2% 24.8%, =0.015), but this was primarily caused by radiographic progression. The incidences of respiratory failure, mechanical ventilation, and septic shock were similar between the groups. Logistic regression analyses revealed that glucocorticoids reduced the risk of treatment failure (=0.367, 95% 0.165-0.818, =0.014). The 30-day in-hospital mortality rates were comparable (8.0% in glucocorticoids 7.2% in controls, =0.811), with indications that glucocorticoids may exert a protective effect on mortality. The PSI score was determined as the sole independent risk factor for 30-day in-hospital mortality (=1.077, 95% 1.032-1.123, =0.001). No evidence indicated that glucocorticoids increased the incidence of hyperglycemia, gastrointestinal bleeding, or 30-day infection recurrence. Glucocorticoids reduce inflammatory cytokine levels and are potentially related to decreased treatment failure and mortality in patients with neutropenic pneumonia classified as PSI Ⅳ and Ⅴ among hematological patients.
本研究旨在探讨糖皮质激素在血液系统疾病患者中，根据肺炎严重程度指数（PSI）被分类为中高风险的中性粒细胞减少性重症肺炎患者中的临床价值。收集了2016年10月至2018年12月期间福建医科大学附属协和医院534例患者的临床资料。我们评估了炎症细胞因子的变化、治疗失败、院内死亡率及其他结局，并通过倾向得分匹配对潜在混杂因素进行校正。患者被分为糖皮质激素组（n = 176）和对照组（n = 358）。糖皮质激素组的C反应蛋白、降钙素原和白细胞介素-6水平较高，PSI评分也较高。在根据倾向得分匹配125对后，除炎症细胞因子水平外，合并症差异减小，糖皮质激素组炎症细胞因子显著降低。糖皮质激素组晚期治疗失败更为常见（39.2%对24.8%，P = 0.015），但这主要是由影像学进展引起的。两组间呼吸衰竭、机械通气和感染性休克的发生率相似。逻辑回归分析显示，糖皮质激素降低了治疗失败的风险（P = 0.367，95%CI 0.165 - 0.818，P = 0.014）。30天院内死亡率相当（糖皮质激素组为8.0%，对照组为7.2%，P = 0.811），有迹象表明糖皮质激素可能对死亡率有保护作用。PSI评分被确定为30天院内死亡率的唯一独立危险因素（P = 1.077，95%CI 1.032 - 1.123，P = 0.001）。没有证据表明糖皮质激素会增加高血糖、胃肠道出血或30天感染复发的发生率。糖皮质激素可降低炎症细胞因子水平，并可能与血液系统患者中PSIⅣ和Ⅴ级中性粒细胞减少性肺炎患者治疗失败和死亡率降低有关。
