Systemic glucocorticoids in the treatment of community-acquired pneumonia: causes of use and absence of a positive effect on the outcome of the disease
Despite the lack of evidence of clear clinical benefit from use, systemic glucocorticoids are often prescribed for community-acquired pneumonia.
Despite the lack of evidence of clear clinical benefit from use, systemic glucocorticoids are often prescribed for community-acquired pneumonia.
Spanish researchers studied the clinical causes of the use of glucocorticoids and their effect on the main results, describing the frequency of use of this group of drugs in clinical practice, the characteristics of patients and the clinical effect of glucocorticoids on the results of the disease.
In a descriptive study, we studied data from 3,257 patients with community-acquired pneumonia diagnosed between June 1997 and January 2008. Of the cohort studied, 260 patients (8%) were prescribed glucocorticoids at an average dose of 36 mg / day. The patients who were prescribed glucocorticoids were older (74 vs 65 years old), they had more concomitant illnesses (respiratory system - 59% vs 38% , cardiovascular pathology - 29% vs 16%), more severe pneumonia (Pneumonia Severity Index or Fine IV-V score - 76% vs 50%) and they were more likely to receive glucocorticoid inhalation (36% vs 15%) and prior antibiotic therapy (31% vs 23%) (all differences are statistically significant, p less than 0, 01).
Predictors of glucocorticoid administration were chronic obstructive pulmonary disease (OR 1.91, 95% confidence interval (CI) 1.34-2.74), fever (OR 0.59, CI 95 % 0.40-0.88), the presence of sputum (OR: 1.59, 95% CI 1.07-2.26), creatinine level (+1 mg / dl, OR 0.92, 95% CI 1.02-1.39), SaO2 greater than 92% (OR 0.46, 95% CI 0.33-0.65), CRP level (+5 mg / dL, OR 0.92, CI at 95% 0.86-0.99) and heart failure (OR 1.76, 95% CI 1.21-2.58).
The mortality rate (6% vs 7%, p = 0.43) and the time until the clinical condition stabilized (4 days vs 5 days , p = 0.11) between the groups does not differ, while the duration of hospitalization is significantly longer in the glucocorticoid group (9 days vs 6 days, p less than 0.01).
Thus, this analysis showed the absence of correlation between the use of glucocorticoids and the lethal outcome or the terms of stabilization of the patient's condition, regardless of the severity of the disease and the cumulative dose of glucocorticoids, however, their use has led to an increase in the length of hospital stay.
The main reasons for the use of glucocorticoids were the presence of chronic pathology of the respiratory system and the severe course of pneumonia, however, this treatment did not affect the mortality or clinical stability of the patient's condition. On the contrary, the administration of glucocorticoids led to a prolongation of hospitalization.
At the same time, in the group of patients receiving glucocorticoids, there was no increase in mortality, as initially assumed based on the assessment of the severity of the patient's condition on the PSI scale. In this regard, the effect of administration of glucocorticoids on the outcomes of community-acquired pneumonia needs to be further investigated in randomized controlled trials.