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Systemic steroid therapy for pneumonic chronic obstructive pulmonary disease exacerbation: A retrospective cohort study

The effectiveness of systemic steroid therapy on mortality in patients with pneumonic chronic obstructive pulmonary disease (COPD) exacerbation is unclear. We evaluated the association between systemic steroid therapy and 30-day mortality after adjusting for known confounders, using data from the He...

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Autores principales: Shiroshita, Akihiro, Anan, Keisuke, Takeshita, Masafumi, Kataoka, Yuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10529550/
https://www.ncbi.nlm.nih.gov/pubmed/37756275
http://dx.doi.org/10.1371/journal.pone.0290647
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author Shiroshita, Akihiro
Anan, Keisuke
Takeshita, Masafumi
Kataoka, Yuki
author_facet Shiroshita, Akihiro
Anan, Keisuke
Takeshita, Masafumi
Kataoka, Yuki
author_sort Shiroshita, Akihiro
collection PubMed
description The effectiveness of systemic steroid therapy on mortality in patients with pneumonic chronic obstructive pulmonary disease (COPD) exacerbation is unclear. We evaluated the association between systemic steroid therapy and 30-day mortality after adjusting for known confounders, using data from the Health, Clinic, and Education Information Evaluation Institute in Japan, which longitudinally followed up patients in the same hospital. We selected patients aged ≥40 years admitted for pneumonic COPD exacerbation. The exclusion criteria were censoring within 24 h, comorbidity with other respiratory diseases, and daily steroid use. Systemic steroid therapy was defined as oral/parenteral steroid therapy initiated within two days of admission. The primary outcome was the 30-day mortality rate. To account for known confounders, each patient was assigned an inverse probability of treatment weighting. The outcome was evaluated using logistic regression. Among 3,662 patients showing pneumonic COPD exacerbation, 30-day mortality in the steroid therapy and non-steroid therapy groups was 27.6% (169/612) and 21.9% (668/3,050), respectively. Systemic steroid therapy indicated a slightly higher estimated probability of 30-day mortality (difference in the estimated probabilities, 2.65%; 95% confidence interval, -1.23 to 6.54%, p-value = 0.181). Systemic steroid therapy within two days of admission was associated with higher 30-day mortality rates in pneumonic COPD exacerbation. Further validation studies based on chart reviews will be needed to cope with residual confounders.
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spelling pubmed-105295502023-09-28 Systemic steroid therapy for pneumonic chronic obstructive pulmonary disease exacerbation: A retrospective cohort study Shiroshita, Akihiro Anan, Keisuke Takeshita, Masafumi Kataoka, Yuki PLoS One Research Article The effectiveness of systemic steroid therapy on mortality in patients with pneumonic chronic obstructive pulmonary disease (COPD) exacerbation is unclear. We evaluated the association between systemic steroid therapy and 30-day mortality after adjusting for known confounders, using data from the Health, Clinic, and Education Information Evaluation Institute in Japan, which longitudinally followed up patients in the same hospital. We selected patients aged ≥40 years admitted for pneumonic COPD exacerbation. The exclusion criteria were censoring within 24 h, comorbidity with other respiratory diseases, and daily steroid use. Systemic steroid therapy was defined as oral/parenteral steroid therapy initiated within two days of admission. The primary outcome was the 30-day mortality rate. To account for known confounders, each patient was assigned an inverse probability of treatment weighting. The outcome was evaluated using logistic regression. Among 3,662 patients showing pneumonic COPD exacerbation, 30-day mortality in the steroid therapy and non-steroid therapy groups was 27.6% (169/612) and 21.9% (668/3,050), respectively. Systemic steroid therapy indicated a slightly higher estimated probability of 30-day mortality (difference in the estimated probabilities, 2.65%; 95% confidence interval, -1.23 to 6.54%, p-value = 0.181). Systemic steroid therapy within two days of admission was associated with higher 30-day mortality rates in pneumonic COPD exacerbation. Further validation studies based on chart reviews will be needed to cope with residual confounders. Public Library of Science 2023-09-27 /pmc/articles/PMC10529550/ /pubmed/37756275 http://dx.doi.org/10.1371/journal.pone.0290647 Text en © 2023 Shiroshita et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Shiroshita, Akihiro
Anan, Keisuke
Takeshita, Masafumi
Kataoka, Yuki
Systemic steroid therapy for pneumonic chronic obstructive pulmonary disease exacerbation: A retrospective cohort study
title Systemic steroid therapy for pneumonic chronic obstructive pulmonary disease exacerbation: A retrospective cohort study
title_full Systemic steroid therapy for pneumonic chronic obstructive pulmonary disease exacerbation: A retrospective cohort study
title_fullStr Systemic steroid therapy for pneumonic chronic obstructive pulmonary disease exacerbation: A retrospective cohort study
title_full_unstemmed Systemic steroid therapy for pneumonic chronic obstructive pulmonary disease exacerbation: A retrospective cohort study
title_short Systemic steroid therapy for pneumonic chronic obstructive pulmonary disease exacerbation: A retrospective cohort study
title_sort systemic steroid therapy for pneumonic chronic obstructive pulmonary disease exacerbation: a retrospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10529550/
https://www.ncbi.nlm.nih.gov/pubmed/37756275
http://dx.doi.org/10.1371/journal.pone.0290647
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