Association Between Systemic Corticosteroid Use and Mortality in Patients with Epiglottitis
Association Between Systemic Corticosteroid Use and Mortality in Patients with Epiglottitis
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DOI：
10.1002/lary.30110
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发表时间：
2022-03-19
期刊：
影响因子：
2.6
通讯作者：
Matsui, Hirotoshi
中科院分区：
文献类型：
--
作者：
Kimura, Yuya;Jo, Taisuke;Matsui, Hirotoshi
目的 阐明在一定剂量下使用全身性皮质类固醇治疗是否与需要气道管理（气管切开术或气道插管）的会厌炎患者有更好的预后相关。方法 这是一项回顾性队列研究，数据来自一个全国性的住院患者数据库（2010年7月至2019年3月），研究对象为因会厌炎需要气道管理而住院的患者。将入院2天内使用相当于甲泼尼龙≥40mg/d的全身性皮质类固醇治疗的患者与入院2天内未使用皮质类固醇治疗的患者进行比较，比较时使用协变量平衡倾向评分进行逆概率治疗加权。主要结局是全因30天住院死亡率，次要结局包括全因7天住院死亡率、住院时长和总医疗费用。结果 皮质类固醇组和对照组分别有1986例和1771例患者。3757例患者中共有72例（1.9%）在入院30天内死亡，其中皮质类固醇组1986例患者中有17例（0.9%）死亡，对照组1771例患者中有55例（3.1%）死亡（加权比值比为0.28[95%置信区间为0.11 - 0.70]；加权风险差为 - 2.2%[ - 3.2%至 - 1.3%]）。使用皮质类固醇治疗与较低的总医疗费用相关（加权中位数为6187美元对6587美元；加权差值为 - 1123美元[ - 2238美元至 - 8美元]），但与全因7天住院死亡率无关（加权比值比为0.63[0.22 - 1.82]；加权风险差为 - 0.3%[ - 0.9至0.2]），与住院时长也无关（加权中位数为13天对13天；加权差值为 - 0.2天[ - 2.1至1.8天]）。结论 全身性皮质类固醇可能对需要气道管理的会厌炎患者有益。证据级别3 《喉镜》，2022年
Objectives To clarify whether treatment with systemic corticosteroids at a certain dose was associated with better outcomes in patients with epiglottitis requiring airway management (tracheotomy or airway intubation). Methods This was a retrospective cohort study on patients hospitalized for epiglottitis requiring airway management from a nationwide inpatient database (between July 2010 and March 2019). Patients treated with systemic corticosteroids equivalent to methylprednisolone >= 40 mg/d within 2 days of admission and patients who were not treated with corticosteroids within 2 days of admission were compared after inverse probability of treatment weighting using covariate balancing propensity score. The primary outcome was all-cause 30-day in-hospital mortality, and secondary outcomes included all-cause 7-day in-hospital mortality, length of hospital stay, and total medical cost. Results There were 1986 and 1771 patients in the corticosteroid and control groups, respectively. A total of 72 of 3757 (1.9%) patients died within 30 days of admission, including 17 of 1986 (0.9%) patients in the corticosteroid group and 55 of 1771 (3.1%) in the control group (weighted odds ratio, 0.28 [95% confidence interval, 0.11-0.70]; weighted risk difference, -2.2% [-3.2% to -1.3%]). Treatment with corticosteroids was associated with lower total medical costs (weighted median, $6,187 vs. $6,587; weighted difference, $-1,123 [-2,238 to -8]) but not all-cause 7-day in-hospital mortality (weighted odds ratio, 0.63 [0.22-1.82]; weighted risk difference, -0.3% [-0.9 to 0.2]) and length of hospital stay (weighted median, 13 vs. 13 days; weighted difference, -0.2 days [-2.1 to 1.8]). Conclusions Systemic corticosteroids may be beneficial to patients with epiglottitis requiring airway management. Level of Evidence 3 Laryngoscope, 2022