You are here

  • Home
  • Archive
  • Volume 10, Issue 10
  • Aetiology and prognostic risk factors of mortality in patients with pneumonia receiving glucocorticoids alone or glucocorticoids and other immunosuppressants: a retrospective cohort study

Article Text

Article menu

Download PDFPDF

XML
Infectious diseases
Original research
Aetiology and prognostic risk factors of mortality in patients with pneumonia receiving glucocorticoids alone or glucocorticoids and other immunosuppressants: a retrospective cohort study
  1. Lijuan Li1,
  2. Steven H Hsu2,
  3. Xiaoying Gu1,
  4. Shan Jiang1,
  5. Lianhan Shang1,
  6. Guolei Sun1,
  7. Lingxiao Sun1,
  8. Li Zhang1,
  9. Chuan Wang3,
  10. Yali Ren4,
  11. Jinxiang Wang5,
  12. Jianliang Pan6,
  13. Jiangbo Liu7,
  14. Cao Bin8
  1. 1Department of Pulmonary and Critical Care Medicine, National Center for Clinical Research on Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
  2. 2Department of Medical Intensive Care Unit, Houston Methodist Hospital, Houston, Texas, USA
  3. 3Department of Pulmonary and Critical Care Medicine, First Hospital of Shijiazhuang, Shijiazhuang, China
  4. 4Department of Pulmonary and Critical Care Medicine, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
  5. 5Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
  6. 6Department of Pulmonary and Critical Care Medicine, Second People’s Hospital of Weifang, Weifang, China
  7. 7Department of Pulmonary and Critical Care Medicine, Tianjin First Central Hospital, Tianjin, China
  8. 8Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Science; Tsinghua University-Peking University Joint Center for Life Sciences, China-Japan Friendship Hospital, Beijing, China
  1. Correspondence to Dr Cao Bin; caobin_ben{at}163.com

Abstract

Objectives Long-term use of high-dose glucocorticoids can lead to severe immunosuppression and increased risk of treatment-resistant pneumonia and mortality. We investigated the aetiology and prognostic risk factors of mortality in hospitalised patients who developed pneumonia while receiving glucocorticoid therapy alone or glucocorticoid and other immunosuppressant therapies.

Design Retrospective cohort study.

Setting Six secondary and tertiary academic hospitals in China.

Participants Patients receiving glucocorticoids who were hospitalised with pneumonia between 1 January 2013 and 31 December 2019.

Main outcomes We analysed the prevalence of comorbidities, microbiology, antibiotic susceptibility patterns, 30-day and 90-day mortality and prognostic risk factors.

Conclusions A total of 716 patients were included, with pneumonia pathogens identified in 69.8% of patients. Significant morbidities occurred, including respiratory failure (50.8%), intensive care unit transfer (40.8%) and mechanical ventilation (36%), with a 90-day mortality of 26.0%. Diagnosis of pneumonia occurred within 6 months of glucocorticoid initiation for 69.7% of patients with Cytomegalovirus (CMV) pneumonia and 79.0% of patients with Pneumocystis jirovecii pneumonia (PCP). Pathogens, including Pneumocystis, CMV and multidrug-resistant bacteria, were identified more frequently in patients with persistent lymphocytopenia and high-dose glucocorticoid treatment (≥30 mg/day of prednisolone or equivalent within 30 days before admission). The 90-day mortality was significantly lower for non-CMV viral pneumonias than for PCP (p<0.05), with a similar mortality as CMV pneumonias (24.2% vs 38.1% vs 27.4%, respectively). Cox regression analysis indicated several independent negative predictors for mortality in this patient population, including septic shock, respiratory failure, persistent lymphocytopenia, interstitial lung disease and high-dose glucocorticoid use.

Patients who developed pneumonia while receiving glucocorticoid therapy experienced high rates of opportunistic infections, with significant morbidity and mortality. These findings should be carefully considered when determining treatment strategies for this patient population.

  • infectious diseases
  • adult intensive & critical care
  • diagnostic microbiology
  • microbiology
  • respiratory infections
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-037419

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Twitter @Li Lijuan

    • Contributors Study design: LL, CB. Data collection: LL, SJ, LSh, GS, LSu, LZ, CW, YR, JW, JP, JL. Statistical analysis: LL, SHH, XG. Writing: LL, CB, SHH. All authors take full responsibility for the study design, data analysis and interpretation, and preparation of the manuscript. All authors approved the final draft of the manuscript.

    • Funding This work was supported by the Ministry of Science and Technology Support Program (Grant: 2015BAI12B11) and the Beijing Science and Technology Commission Key Project (Grant: D151100002115004).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Parental/guardian consent obtained.

    • Ethics approval The Ethics Committee of China-Japan Friendship Hospital (No 2015-86) granted approval for this retrospective study and orchestrated centralised collaboration and approval of all participating institutions, including anonymised data submission and collection.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available in a public, open access repository. Extra data can be accessed via the Dryad data repository at https://datadryad.org/stashe with the doi:10.5061/dryad.mkkwh70x2.