tetano
Editor, Senior Moderator
Influenza Other Respir Viruses. 2017 May 2. doi: 10.1111/irv.12456. [Epub ahead of print]
[h=1]Effect of low-to-moderate dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 viral pneumonia.[/h] Li H[SUP]1[/SUP], Yang SG[SUP]2[/SUP], Gu L[SUP]1[/SUP], Zhang Y[SUP]3[/SUP], Yan XX[SUP]4[/SUP], Liang ZA[SUP]5[/SUP], Zhang W[SUP]6[/SUP], Jia HY[SUP]2[/SUP], Chen W[SUP]7[/SUP], Liu M[SUP]1[/SUP], Yu KJ[SUP]8[/SUP], Xue CX[SUP]1[/SUP], Hu K[SUP]9[/SUP], Zou Q[SUP]10[/SUP], Li LJ[SUP]2[/SUP], Cao B[SUP]11,[/SUP][SUP]12,[/SUP][SUP]13,[/SUP][SUP]14[/SUP], Wang C[SUP]11,[/SUP][SUP]12,[/SUP][SUP]13,[/SUP][SUP]14[/SUP]; National Influenza A(H1N1)pdm09 Clinical Investigation Group of China.
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] The effect of corticosteroids on influenza A(H1N1)pdm09 viral pneumonia patients remains controversial and the impact of dosage has never been studied.
[h=4]METHODS:[/h] 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[SUP]-1[/SUP] ) and high-dose (> 150 mg?day[SUP]-1[/SUP] ) corticosteroids on 30-day mortality, 60-day mortality, and nosocomial infection were assessed with multivariate Cox regression and propensity score-matched case-control analysis.
[h=4]RESULTS:[/h] In total, 2141 patients (median age: 34 y; morality rate: 15.9%) were included. Among them, 1160 (54.2%) had PaO[SUB]2[/SUB] /FiO[SUB]2[/SUB] < 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 PaO[SUB]2[/SUB] /FiO[SUB]2[/SUB] < 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 PaO[SUB]2[/SUB] /FiO[SUB]2[/SUB] ≥ 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.
[h=4]CONCLUSIONS:[/h] Low-to-moderate dose corticosteroids might reduce mortality of influenza A(H1N1)pdm09 viral pneumonia patients with PaO[SUB]2[/SUB] /FiO[SUB]2[/SUB] < 300 mmHg. Mild patients with PaO[SUB]2[/SUB] /FiO[SUB]2[/SUB] ≥ 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.
[h=4]KEYWORDS:[/h] corticosteroids; influenza A(H1N1)pdm09 virus; mortality; pneumonia
PMID: 28464462 DOI: 10.1111/irv.12456
Free full text
[h=1]Effect of low-to-moderate dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 viral pneumonia.[/h] Li H[SUP]1[/SUP], Yang SG[SUP]2[/SUP], Gu L[SUP]1[/SUP], Zhang Y[SUP]3[/SUP], Yan XX[SUP]4[/SUP], Liang ZA[SUP]5[/SUP], Zhang W[SUP]6[/SUP], Jia HY[SUP]2[/SUP], Chen W[SUP]7[/SUP], Liu M[SUP]1[/SUP], Yu KJ[SUP]8[/SUP], Xue CX[SUP]1[/SUP], Hu K[SUP]9[/SUP], Zou Q[SUP]10[/SUP], Li LJ[SUP]2[/SUP], Cao B[SUP]11,[/SUP][SUP]12,[/SUP][SUP]13,[/SUP][SUP]14[/SUP], Wang C[SUP]11,[/SUP][SUP]12,[/SUP][SUP]13,[/SUP][SUP]14[/SUP]; National Influenza A(H1N1)pdm09 Clinical Investigation Group of China.
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] The effect of corticosteroids on influenza A(H1N1)pdm09 viral pneumonia patients remains controversial and the impact of dosage has never been studied.
[h=4]METHODS:[/h] 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[SUP]-1[/SUP] ) and high-dose (> 150 mg?day[SUP]-1[/SUP] ) corticosteroids on 30-day mortality, 60-day mortality, and nosocomial infection were assessed with multivariate Cox regression and propensity score-matched case-control analysis.
[h=4]RESULTS:[/h] In total, 2141 patients (median age: 34 y; morality rate: 15.9%) were included. Among them, 1160 (54.2%) had PaO[SUB]2[/SUB] /FiO[SUB]2[/SUB] < 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 PaO[SUB]2[/SUB] /FiO[SUB]2[/SUB] < 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 PaO[SUB]2[/SUB] /FiO[SUB]2[/SUB] ≥ 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.
[h=4]CONCLUSIONS:[/h] Low-to-moderate dose corticosteroids might reduce mortality of influenza A(H1N1)pdm09 viral pneumonia patients with PaO[SUB]2[/SUB] /FiO[SUB]2[/SUB] < 300 mmHg. Mild patients with PaO[SUB]2[/SUB] /FiO[SUB]2[/SUB] ≥ 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.
[h=4]KEYWORDS:[/h] corticosteroids; influenza A(H1N1)pdm09 virus; mortality; pneumonia
PMID: 28464462 DOI: 10.1111/irv.12456
Free full text