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首页> 外文期刊>International Journal of General Medicine >Impact and indication of early systemic corticosteroids for very severe community-acquired pneumonia
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Impact and indication of early systemic corticosteroids for very severe community-acquired pneumonia

机译：早期全身性皮质类固醇激素对非常严重的社区获得性肺炎的影响和适应症

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Background: The efficacy of systemic corticosteroids in community-acquired pneumonia (CAP) has not yet been confirmed. We prospectively investigated the clinical features of patients treated with early adjunctive systemic corticosteroids and its clinical impact in very severe CAP.Methods: One hundred and one consecutive CAP patients having a pneumonia severity index of >130 points were enrolled from August 2010 through February 2013. Early adjunctive systemic corticosteroids were defined as administration of systemic corticosteroids equivalent to prednisone of ≥20 mg/day added to initial antibiotics. The multivariate analysis was performed to evaluate the independent factors associated with mortality.Results: Thirty-two patients (31.7%) died within 28 days of admission. Early adjunctive systemic corticosteroids were administered in 30 patients (29.7%), who more frequently had alteration of mental status, serious respiratory failure, or underlying lung diseases and received fluoroquinolones as initial antibiotics. In most patients treated with early adjunctive systemic corticosteroids, the dosage was less than 60 mg/day of an equivalent to prednisone by bolus intravenous infusion for a period shorter than 8 days. The occurrence of adverse events did not differ between the groups. Factors independently associated with mortality were blood urea nitrogen (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.00–1.04), serum albumin (HR 0.44, 95% CI 0.22–0.86), a requirement for intensive care (HR 4.93, 95% CI 1.75–13.87), and the therapy with early adjunctive systemic corticosteroids (HR 0.29, 95% CI 0.11–0.81).Conclusion: Early adjunctive systemic corticosteroids may have an effect to reduce the mortality in very severe CAP, although a larger-scale study is necessary.
机译：背景：全身性糖皮质激素在社区获得性肺炎（CAP）中的疗效尚未得到证实。我们前瞻性研究了早期辅助全身性皮质类固醇激素治疗的患者的临床特征及其在非常严重的CAP中的临床影响。方法：从2010年8月至2013年2月，入选了110例肺炎严重程度指数大于130点的CAP患者。早期辅助性全身性皮质类固醇的定义是，在初始抗生素中添加等同于泼尼松≥20 mg /天的全身性皮质类固醇。进行多因素分析以评估与死亡率相关的独立因素。结果：32例患者（31.7％）在入院后28天内死亡。早期辅助性全身性激素治疗30例（29.7％），他们的心理状况改变，严重的呼吸衰竭或潜在的肺部疾病更常见，并接受氟喹诺酮类药物作为初始抗生素。在大多数接受早期辅助全身性皮质类固醇治疗的患者中，推注静脉输注的剂量少于泼尼松的60 mg /天（少于8天）。两组之间不良事件的发生率没有差异。与死亡率独立相关的因素是血尿素氮（危险比[HR] 1.02，95％置信区间[CI] 1.00–1.04），血清白蛋白（HR 0.44，95％CI 0.22–0.86），需要重症监护（HR） 4.93，95％CI 1.75–13.87），以及早期辅助性全身性糖皮质激素治疗（HR 0.29，95％CI 0.11-0.81）。结论：早期辅助性全身性糖皮质激素可降低非常严重的CAP死亡率。有必要进行大规模研究。

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