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 efects on survival have precluded their widespread implementation. We aimed to eval...

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Autores: Ceccato, Adrian, Russo, A., Barbeta, Enric, Oscanoa, Patricia, Tiseo, Giusy, Gabarrús, Albert, Di Giannatale, Pierluigi, Nogas, Stefano, Cillóniz, Catia, Menichetti, F., Ferrer Monreal, Miquel, Niederman, Michael S., Falcone, Marco, Torres Martí, Antoni
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/185931
Acceso en línea:https://hdl.handle.net/2445/185931
Access Level:acceso abierto
Palabra clave:Pneumònia adquirida a la comunitat
Mortalitat
Corticosteroides
Assaigs clínics
Septicèmia
Community-acquired pneumonia
Mortality
Adrenocortical hormones
Clinical trials
Septicemia
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spelling Real-world corticosteroid use in severe pneumonia: a propensity-score-matched studyCeccato, AdrianRusso, A.Barbeta, EnricOscanoa, PatriciaTiseo, GiusyGabarrús, AlbertDi Giannatale, PierluigiNogas, StefanoCillóniz, CatiaMenichetti, F.Ferrer Monreal, MiquelNiederman, Michael S.Falcone, MarcoTorres Martí, AntoniPneumònia adquirida a la comunitatMortalitatCorticosteroidesAssaigs clínicsSepticèmiaCommunity-acquired pneumoniaMortalityAdrenocortical hormonesClinical trialsSepticemiaBackground: 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 efects on survival have precluded their widespread implementation. We aimed to evaluate whether corticosteroids might improve clinical outcomes in patients with severe CAP and high infammatory 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 infammatory 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 signifcantly 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-eightday 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% confdence interval (CI) 0.29-0.98) (p=0.043). In patients who did not meet major severity criteria, no benefts were observed with corticosteroid use (HR 0.88 (95%CI 0.32-2.36). Conclusions: Corticosteroid treatment may be of beneft for patients with CAP who have septic shock and/or a high infammatory response and requirement for invasive mechanical ventilation. Corticosteroids appear to have no impact on mortality when these features are not present.BioMed Central2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/185931Articles publicats en revistes (Medicina)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1186/s13054-021-03840-xCritical Care, 2021, vol. 25, num. 1, p. 432-438https://doi.org/10.1186/s13054-021-03840-xcc-by (c) Ceccato, Adrian et al., 2021https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1859312026-05-27T06:46:51Z
dc.title.none.fl_str_mv 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
spellingShingle Real-world corticosteroid use in severe pneumonia: a propensity-score-matched study
Ceccato, Adrian
Pneumònia adquirida a la comunitat
Mortalitat
Corticosteroides
Assaigs clínics
Septicèmia
Community-acquired pneumonia
Mortality
Adrenocortical hormones
Clinical trials
Septicemia
title_short 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_sort Real-world corticosteroid use in severe pneumonia: a propensity-score-matched study
dc.creator.none.fl_str_mv Ceccato, Adrian
Russo, A.
Barbeta, Enric
Oscanoa, Patricia
Tiseo, Giusy
Gabarrús, Albert
Di Giannatale, Pierluigi
Nogas, Stefano
Cillóniz, Catia
Menichetti, F.
Ferrer Monreal, Miquel
Niederman, Michael S.
Falcone, Marco
Torres Martí, Antoni
author Ceccato, Adrian
author_facet Ceccato, Adrian
Russo, A.
Barbeta, Enric
Oscanoa, Patricia
Tiseo, Giusy
Gabarrús, Albert
Di Giannatale, Pierluigi
Nogas, Stefano
Cillóniz, Catia
Menichetti, F.
Ferrer Monreal, Miquel
Niederman, Michael S.
Falcone, Marco
Torres Martí, Antoni
author_role author
author2 Russo, A.
Barbeta, Enric
Oscanoa, Patricia
Tiseo, Giusy
Gabarrús, Albert
Di Giannatale, Pierluigi
Nogas, Stefano
Cillóniz, Catia
Menichetti, F.
Ferrer Monreal, Miquel
Niederman, Michael S.
Falcone, Marco
Torres Martí, Antoni
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Pneumònia adquirida a la comunitat
Mortalitat
Corticosteroides
Assaigs clínics
Septicèmia
Community-acquired pneumonia
Mortality
Adrenocortical hormones
Clinical trials
Septicemia
topic Pneumònia adquirida a la comunitat
Mortalitat
Corticosteroides
Assaigs clínics
Septicèmia
Community-acquired pneumonia
Mortality
Adrenocortical hormones
Clinical trials
Septicemia
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 efects on survival have precluded their widespread implementation. We aimed to evaluate whether corticosteroids might improve clinical outcomes in patients with severe CAP and high infammatory 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 infammatory 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 signifcantly 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-eightday 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% confdence interval (CI) 0.29-0.98) (p=0.043). In patients who did not meet major severity criteria, no benefts were observed with corticosteroid use (HR 0.88 (95%CI 0.32-2.36). Conclusions: Corticosteroid treatment may be of beneft for patients with CAP who have septic shock and/or a high infammatory response and requirement for invasive mechanical ventilation. Corticosteroids appear to have no impact on mortality when these features are not present.
publishDate 2021
dc.date.none.fl_str_mv 2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/185931
url https://hdl.handle.net/2445/185931
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1186/s13054-021-03840-x
Critical Care, 2021, vol. 25, num. 1, p. 432-438
https://doi.org/10.1186/s13054-021-03840-x
dc.rights.none.fl_str_mv cc-by (c) Ceccato, Adrian et al., 2021
https://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Ceccato, Adrian et al., 2021
https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
dc.source.none.fl_str_mv Articles publicats en revistes (Medicina)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,298079

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