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Effect of low-to-moderate dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 viral pneumonia

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  • Effect of low-to-moderate dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 viral pneumonia

    Influenza Other Respir Viruses. 2017 May 2. doi: 10.1111/irv.12456. [Epub ahead of print]
    Effect of low-to-moderate dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 viral pneumonia.

    Li H1, Yang SG2, Gu L1, Zhang Y3, Yan XX4, Liang ZA5, Zhang W6, Jia HY2, Chen W7, Liu M1, Yu KJ8, Xue CX1, Hu K9, Zou Q10, Li LJ2, Cao B11,12,13,14, Wang C11,12,13,14; National Influenza A(H1N1)pdm09 Clinical Investigation Group of China.
    Author information

    Abstract

    BACKGROUND:

    The effect of corticosteroids on influenza A(H1N1)pdm09 viral pneumonia patients remains controversial and the impact of dosage has never been studied.
    METHODS:

    Using data of hospitalized adolescent and adult patients with influenza A(H1N1)pdm09 viral pneumonia, prospectively collected from 407 hospitals in mainland China, the effects of low-to-moderate dose (25-150 mg?day-1 ) and high-dose (> 150 mg?day-1 ) corticosteroids on 30-day mortality, 60-day mortality, and nosocomial infection were assessed with multivariate Cox regression and propensity score-matched case-control analysis.
    RESULTS:

    In total, 2141 patients (median age: 34 y; morality rate: 15.9%) were included. Among them, 1160 (54.2%) had PaO2 /FiO2 < 300 mmHg on admission, and 1055 (49.3%) received corticosteroids therapy. Corticosteroids, without consideration of dose, did not influence either 30-day or 60-day mortality. Further analysis revealed that, as compared with the no-corticosteroid group, low-to-moderate dose corticosteroids was related to reduced 30-day mortality (adjusted hazard ratio [aHR] 0.64 [95%CI 0.43-0.96, p=0.033]). In the subgroup analysis among patients with PaO2 /FiO2 < 300 mmHg, low-to-moderate dose corticosteroid treatment significantly reduced both 30-day (aHR 0.49 [95%CI 0.32-0.77]) and 60-day mortality (aHR 0.51 [95%CI 0.33-0.78]), while high-dose corticosteroid therapy yielded no difference. For patients with PaO2 /FiO2 ≥ 300 mmHg, corticosteroids (irrespective of dose) showed no benefit, and even increased 60-day mortality (aHR 3.02 [95%CI 1.06-8.58]). Results were similar in the propensity model analysis.
    CONCLUSIONS:

    Low-to-moderate dose corticosteroids might reduce mortality of influenza A(H1N1)pdm09 viral pneumonia patients with PaO2 /FiO2 < 300 mmHg. Mild patients with PaO2 /FiO2 ≥ 300 mmHg could not benefit from corticosteroids therapy. This article is protected by copyright. All rights reserved.
    This article is protected by copyright. All rights reserved.


    KEYWORDS:

    corticosteroids; influenza A(H1N1)pdm09 virus; mortality; pneumonia

    PMID: 28464462 DOI: 10.1111/irv.12456
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