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Real-world corticosteroid use in severe pneumonia: a propensity-score-matched study
BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide despite correct antibiotic use. Corticosteroids have long been evaluated as a treatment option, but heterogeneous effects on survival have precluded their widespread implementation. We aimed to eva...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674860/ https://www.ncbi.nlm.nih.gov/pubmed/34915895 http://dx.doi.org/10.1186/s13054-021-03840-x |
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author | Ceccato, A. Russo, A. Barbeta, E. Oscanoa, P. Tiseo, G. Gabarrus, A. Di Giannatale, P. Nogas, S. Cilloniz, C. Menichetti, F. Ferrer, M. Niederman, M. Falcone, M. Torres, A. |
author_facet | Ceccato, A. Russo, A. Barbeta, E. Oscanoa, P. Tiseo, G. Gabarrus, A. Di Giannatale, P. Nogas, S. Cilloniz, C. Menichetti, F. Ferrer, M. Niederman, M. Falcone, M. Torres, A. |
author_sort | Ceccato, A. |
collection | PubMed |
description | BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide despite correct antibiotic use. Corticosteroids have long been evaluated as a treatment option, but heterogeneous effects on survival have precluded their widespread implementation. We aimed to evaluate whether corticosteroids might improve clinical outcomes in patients with severe CAP and high inflammatory responses. STUDY DESIGN AND METHODS: We analyzed two prospective observational cohorts of patients with CAP in Barcelona and Rome who were admitted to intensive care with a high inflammatory response. Propensity score (PS) matching was used to obtain balance among the baseline variables in both groups, and we excluded patients with viral pneumonia or who received hydrocortisone. RESULTS: Of the 610 patients admitted with severe CAP, 198 (32%) received corticosteroids and 387 had major criteria for severe CAP. All patients had a baseline serum C-reactive protein above 15 mg/dL. Patients who received corticosteroids were more commonly male, had more comorbidities (e.g., cancer or chronic obstructive pulmonary disease), and presented with significantly higher sequential organ failure assessment scores. Eighty-nine patients met major severity criteria (invasive mechanical ventilation and/or septic shock) and were matched per group. Twenty-eight-day mortality was lower among patients receiving corticosteroids (16 patients, 18%) than among those not receiving them (28 patients, 31%; p = 0.037). After PS matching, corticosteroid therapy reduced the 28-day mortality risk in patients who met major severity criteria (hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.29–0.98) (p = 0.043). In patients who did not meet major severity criteria, no benefits were observed with corticosteroid use (HR 0.88 (95%CI 0.32–2.36). CONCLUSIONS: Corticosteroid treatment may be of benefit for patients with CAP who have septic shock and/or a high inflammatory response and requirement for invasive mechanical ventilation. Corticosteroids appear to have no impact on mortality when these features are not present. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-021-03840-x. |
format | Online Article Text |
id | pubmed-8674860 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-86748602021-12-16 Real-world corticosteroid use in severe pneumonia: a propensity-score-matched study Ceccato, A. Russo, A. Barbeta, E. Oscanoa, P. Tiseo, G. Gabarrus, A. Di Giannatale, P. Nogas, S. Cilloniz, C. Menichetti, F. Ferrer, M. Niederman, M. Falcone, M. Torres, A. Crit Care Research BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide despite correct antibiotic use. Corticosteroids have long been evaluated as a treatment option, but heterogeneous effects on survival have precluded their widespread implementation. We aimed to evaluate whether corticosteroids might improve clinical outcomes in patients with severe CAP and high inflammatory responses. STUDY DESIGN AND METHODS: We analyzed two prospective observational cohorts of patients with CAP in Barcelona and Rome who were admitted to intensive care with a high inflammatory response. Propensity score (PS) matching was used to obtain balance among the baseline variables in both groups, and we excluded patients with viral pneumonia or who received hydrocortisone. RESULTS: Of the 610 patients admitted with severe CAP, 198 (32%) received corticosteroids and 387 had major criteria for severe CAP. All patients had a baseline serum C-reactive protein above 15 mg/dL. Patients who received corticosteroids were more commonly male, had more comorbidities (e.g., cancer or chronic obstructive pulmonary disease), and presented with significantly higher sequential organ failure assessment scores. Eighty-nine patients met major severity criteria (invasive mechanical ventilation and/or septic shock) and were matched per group. Twenty-eight-day mortality was lower among patients receiving corticosteroids (16 patients, 18%) than among those not receiving them (28 patients, 31%; p = 0.037). After PS matching, corticosteroid therapy reduced the 28-day mortality risk in patients who met major severity criteria (hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.29–0.98) (p = 0.043). In patients who did not meet major severity criteria, no benefits were observed with corticosteroid use (HR 0.88 (95%CI 0.32–2.36). CONCLUSIONS: Corticosteroid treatment may be of benefit for patients with CAP who have septic shock and/or a high inflammatory response and requirement for invasive mechanical ventilation. Corticosteroids appear to have no impact on mortality when these features are not present. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-021-03840-x. BioMed Central 2021-12-16 /pmc/articles/PMC8674860/ /pubmed/34915895 http://dx.doi.org/10.1186/s13054-021-03840-x Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Ceccato, A. Russo, A. Barbeta, E. Oscanoa, P. Tiseo, G. Gabarrus, A. Di Giannatale, P. Nogas, S. Cilloniz, C. Menichetti, F. Ferrer, M. Niederman, M. Falcone, M. Torres, A. Real-world corticosteroid use in severe pneumonia: a propensity-score-matched study |
title | Real-world corticosteroid use in severe pneumonia: a propensity-score-matched study |
title_full | Real-world corticosteroid use in severe pneumonia: a propensity-score-matched study |
title_fullStr | Real-world corticosteroid use in severe pneumonia: a propensity-score-matched study |
title_full_unstemmed | Real-world corticosteroid use in severe pneumonia: a propensity-score-matched study |
title_short | Real-world corticosteroid use in severe pneumonia: a propensity-score-matched study |
title_sort | real-world corticosteroid use in severe pneumonia: a propensity-score-matched study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674860/ https://www.ncbi.nlm.nih.gov/pubmed/34915895 http://dx.doi.org/10.1186/s13054-021-03840-x |
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