Low-dose corticosteroid use and mortality in severe community-acquired pneumonia patients

Abstract

The relationship between low-dose corticosteroid use and mortality in patients with severe community-acquired pneumonia (CAP) remains unclear.6925 patients with severe CAP who received mechanical ventilation with or without shock (defined as use of catecholamines) at 983 hospitals were identified using a Japanese nationwide administrative database. The main outcome measure was 28-day mortality.2524 patients with severe CAP who received catecholamines were divided into corticosteroid (n=631) and control (n=1893) groups. The 28-day mortality was significantly different between corticosteroid and control groups (unmatched: 24.6% versus 36.3%, p<0.001; propensity score-matched: 25.3% versus 32.6%, p=0.01; inverse probability-weighted: 27.5% versus 34.2%, p<0.001). 4401 patients with severe CAP who did not receive catecholamines were also divided into corticosteroid (n=1112) and control (n=3289) groups. The 28-day mortality was not significantly different between corticosteroid and control groups in propensity score-matched analyses (unmatched: 16.0% versus 19.4%, p=0.01; propensity score-matched: 17.7% versus 15.6%, p=0.22; inverse probability-weighted: 18.8% versus 18.2%, p=0.44).Low-dose corticosteroid use may be associated with reduced 28-day mortality in patients with septic shock complicating CAP. @ERSpublications Low-dose corticosteroids in severe CAP patients was associated with better prognosis only in those with septic shock

Thoracic Aortic Injury in Japan

“…Figure 5 shows the proportion of endovascular repair use within 24 h (ie, one of the following: died in emergency room before admission, died within 24 h of admission, or survived at least for more than 24 h after admission); and discharge status. 19, 20 The dates of hospital admission, surgery, bedside procedures, drugs administered, and discharge are recorded using a uniform data submission format. The data collection period for the database was July to December 2007-2010, and throughout the year since 2011.…”

“…19, 20 The da- Patient selection for analysis in a nationwide retrospective cohort study of thoracic aortic injury in Japan. ER, emergency room.…”

“…The JCS score is well correlated with the Glasgow Coma Scale (GCS) score, and a JCS score of 100 is equivalent to a GCS score of 6-9. 19, 20 The hospital type was categorized as academic or non-academic, and teaching or non-teaching. Hospital volume was defined as the number of patients with thoracic aortic injury admitted within the study period (ie, 51 months).…”

Corticosteroids in the adjunctive therapy of community-acquired pneumonia: an appraisal of recent meta-analyses of clinical trials

“…Characterisation of the beneficial mechanisms of CS-mediated anti-inflammatory activity such as attenuation of Jarisch-Herxheimer-like reactions Identification of sub-groups of patients, possibly those with high systemic inflammatory indices, who are likely to benefit most from CS adjunctive therapy Identification of the most reliable systemic, inflammatory biomarkers predictive of responsiveness to CS greater than 150 mg/L, and those with shock requiring vasopressor support, appear to experience greatest benefit, as suggested by the meta-analyses and by several of the investigators (14,35,44).…”

“…Tagami and colleagues undertook a retrospective record review of adult patients (≥18 years) with severe CAP, requiring MV, who had received catecholamines (for septic shock) (35). Patients were divided into two groups based on whether they had received CS (n=631) or not (n=1,893).…”