Outcomes Associated with Corticosteroid Dosage in Critically III Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease
Outcomes Associated with Corticosteroid Dosage in Critically III Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease
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DOI：
10.1164/rccm.201401-0058oc
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发表时间：
2014-05-01
影响因子：
24.7
通讯作者：
Vandivier, R. William
中科院分区：
文献类型：
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作者：
Kiser, Tyree H.;Allen, Richard R.;Vandivier, R. William
理由：评估慢性阻塞性肺疾病（AECOPD）急性加重住院患者皮质类固醇（CS）给药的研究在很大程度上排除了直接进入重症监护室（ICU）的患者，并且没有评估CS给药方案对死亡率的影响。目的：检查低剂量与高剂量CS在AECOPD患者中的有效性和安全性。方法：这项药物流行病学队列研究评价了2003年1月1日至2008年12月31日期间在473家医院之一住院并在前2天内接受CS治疗的ICU AECOPD患者。根据住院第1天或第2天的CS剂量，将患者分组为低剂量（甲基强的松龙，240 mg/d）组。主要结果是住院死亡率。测量和主要结果：共纳入17，239例患者;低剂量组6，156例（36%），高剂量组11，083例（64%）。在倾向评分匹配和调整不平衡协变量后，低剂量CS与死亡率显著降低无关（比值比，0.85; 95%置信区间[CI]，0.71-1.01; P=0.06），但与住院时间减少相关（-0.44 d; 95% CI，-0.67至-0.21; P
Rationale: Studies evaluating corticosteroid (CS) dosing for patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) have largely excluded patients admitted directly to the intensive care unit (ICU), and none have evaluated the effect of CS dosing regimens on mortality.Objectives: To examine the effectiveness and safety of lower-versus high-dose CS in patients admitted to the ICU with an AECOPD.Methods: This pharmacoepidemiologic cohort study evaluated ICU patients with AECOPD admitted to one of 473 hospitals and treated with CS within the first 2 days between January 1, 2003 and December 31, 2008. Patients were grouped into lower-dose (methylprednisolone, 240 mg/d) groups based on CS dosage on hospital Day 1 or 2. The primary outcome was hospital mortality.Measurements and Main Results: A total of 17,239 patients were included; 6,156 (36%) were in the lower-dose and 11,083(64%) in the high-dose CS group. After propensity score matching and adjustment for unbalanced covariates, lower-dose CS was not associated with a significant reduction in mortality (odds ratio, 0.85; 95% confidence interval [CI], 0.71-1.01; P=0.06), but it was associated with reduced hospital (-0.44 d; 95% CI, -0.67 to -0.21; P