Preadmission Corticosteroid Therapy and the Risk of Respiratory Failure in Adults Without HIV Presenting With Pneumocystis Pneumonia
BACKGROUND: Corticosteroid therapy is a well-recognized risk factor for Pneumocystis pneumonia (PCP); however, it has also been proposed as an adjunct to decrease inflammation and respiratory failure.
OBJECTIVE: To determine the association between preadmission corticosteroid use and risk of moderate-to-severe respiratory failure at the time of PCP presentation.
METHODS: This retrospective cohort study evaluated HIV-negative immunosuppressed adults diagnosed with PCP at Mayo Clinic from 2006 to 2016. Multivariable regression models were used to evaluate the association between preadmission corticosteroid exposure and moderate-to-severe respiratory failure at presentation.
RESULTS: Of the 323 patients included, 174 (54%) used preadmission corticosteroids with a median daily dosage of 20 (interquartile range: 10-40) mg of prednisone or equivalent. After adjustment for baseline demographics, preadmission corticosteroid therapy did not decrease respiratory failure at the time of PCP presentation (odds ratio: 1.23, 95% confidence interval: 0.73-2.09, P = .38). Additionally, after adjusting for inpatient corticosteroid administration, preadmission corticosteroid use did not impact the need for intensive care unit admission (P = .98), mechanical ventilation (P = .92), or 30-day mortality (P = .11).
CONCLUSIONS: Corticosteroid exposure before PCP presentation in immunosuppressed HIV-negative adults was not associated with a reduced risk of moderate-to-severe respiratory failure.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2020 |
|---|---|
| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:35 |
|---|---|
| Enthalten in: |
Journal of intensive care medicine - 35(2020), 12 vom: 05. Dez., Seite 1465-1470 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Wieruszewski, Patrick M [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Adrenal Cortex Hormones |
|---|
| Anmerkungen: |
Date Completed 29.07.2021 Date Revised 18.04.2022 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1177/0885066619834242 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM294383832 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM294383832 | ||
| 003 | DE-627 | ||
| 005 | 20231225081349.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2020 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1177/0885066619834242 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0981.xml |
| 035 | |a (DE-627)NLM294383832 | ||
| 035 | |a (NLM)30813829 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Wieruszewski, Patrick M |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Preadmission Corticosteroid Therapy and the Risk of Respiratory Failure in Adults Without HIV Presenting With Pneumocystis Pneumonia |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 29.07.2021 | ||
| 500 | |a Date Revised 18.04.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Corticosteroid therapy is a well-recognized risk factor for Pneumocystis pneumonia (PCP); however, it has also been proposed as an adjunct to decrease inflammation and respiratory failure | ||
| 520 | |a OBJECTIVE: To determine the association between preadmission corticosteroid use and risk of moderate-to-severe respiratory failure at the time of PCP presentation | ||
| 520 | |a METHODS: This retrospective cohort study evaluated HIV-negative immunosuppressed adults diagnosed with PCP at Mayo Clinic from 2006 to 2016. Multivariable regression models were used to evaluate the association between preadmission corticosteroid exposure and moderate-to-severe respiratory failure at presentation | ||
| 520 | |a RESULTS: Of the 323 patients included, 174 (54%) used preadmission corticosteroids with a median daily dosage of 20 (interquartile range: 10-40) mg of prednisone or equivalent. After adjustment for baseline demographics, preadmission corticosteroid therapy did not decrease respiratory failure at the time of PCP presentation (odds ratio: 1.23, 95% confidence interval: 0.73-2.09, P = .38). Additionally, after adjusting for inpatient corticosteroid administration, preadmission corticosteroid use did not impact the need for intensive care unit admission (P = .98), mechanical ventilation (P = .92), or 30-day mortality (P = .11) | ||
| 520 | |a CONCLUSIONS: Corticosteroid exposure before PCP presentation in immunosuppressed HIV-negative adults was not associated with a reduced risk of moderate-to-severe respiratory failure | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a PCP | |
| 650 | 4 | |a PJP | |
| 650 | 4 | |a immunosuppression | |
| 650 | 4 | |a pneumocystis | |
| 650 | 4 | |a respiratory failure | |
| 650 | 7 | |a Adrenal Cortex Hormones |2 NLM | |
| 700 | 1 | |a Barreto, Erin F |e verfasserin |4 aut | |
| 700 | 1 | |a Barreto, Jason N |e verfasserin |4 aut | |
| 700 | 1 | |a Yadav, Hemang |e verfasserin |4 aut | |
| 700 | 1 | |a Tosh, Pritish K |e verfasserin |4 aut | |
| 700 | 1 | |a Mara, Kristin C |e verfasserin |4 aut | |
| 700 | 1 | |a Limper, Andrew H |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of intensive care medicine |d 1991 |g 35(2020), 12 vom: 05. Dez., Seite 1465-1470 |w (DE-627)NLM08584439X |x 1525-1489 |7 nnns |
| 773 | 1 | 8 | |g volume:35 |g year:2020 |g number:12 |g day:05 |g month:12 |g pages:1465-1470 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1177/0885066619834242 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 35 |j 2020 |e 12 |b 05 |c 12 |h 1465-1470 | ||